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Use of Local Anesthesia Prior to Finger Extension Following Injection of Collagenase Clostridium Histolyticum for Dupuytren's Contracture
Stephen Coleman, MBBS1; David Gilpin, MBBS1; Nigel Jones, BSc2; James P. Tursi, MD3; Brian M. Cohen, PhD3; Gregory J. Kaufman, MD3
1Brisbane Hand & Upper Limb Center, Brisbane, Australia, 2Auxilium Pharmaceuticals, Inc, Windsor, United Kingdom, 3Auxilium Pharmaceuticals, Inc, Chesterbrook, PA

Introduction: Collagenase clostridium histolyticum (CCH) is a nonsurgical treatment option in the US for adult patients with Dupuytren's contracture with a palpable cord. CCH injections are followed by a finger extension procedure that occurs the following day. We analyzed data from a recent clinical trial to evaluate whether local anesthesia (LA), per physician practice and patient preference, prior to finger extension was associated with greater improvement of contracture.

Materials and Methods: Data were analyzed from a multicenter, open-label, Phase 3b study. Patients (n=60) received two CCH injections into cords of two affected joints in the same hand during one visit (120 treated joints; 75 metacarpophalangeal [MP], 45 proximal interphalangeal [PIP]), followed by finger extension ~24 hours later. Outcomes at Day 30 post-injection, including fixed flexion contracture (FFC) and rates of clinical success (ie, FFC≤5°), were analyzed for patients who did or did not receive LA prior to finger extension.

Results: Overall 27/60 patients (45%) received LA prior to finger extension. Use of LA among subgroups (by joints/fingers treated) is summarized in Table 1. Patients receiving LA had more severe baseline contractures (total FFC 90.3° vs 84.°) but had significantly greater improvements from baseline (82.6% vs 69.8%; P=0.04) (Table 2). Percent improvement from baseline FFC for PIP joints were 74.7% with LA and 59.7% without LA (P=0.07), and for MP joints were 87.8% and 83.8%, respectively (P=0.49) (Table 2). Clinical success rates for PIP joints were 44.4% (8/18) with LA and 25.9% (7/27) without LA (P=0.22), and for MP joints were 77.8% (28/36) and 74.4% (29/39), respectively (P=0.79). Use of anesthesia resulted in slightly higher rate of skin tears, all of which healed without complications or additional surgical procedures. There were no meaningful differences in adverse events between those who received anesthesia and those who did not.

Conclusions: Patients receiving LA had significantly better responses despite having more severe contractures. PIP joints tended to show a better response in terms of percent improvement from baseline and rate of clinical success with LA versus without LA. MP joints showed similar responses regardless of LA use. No safety differences were observed.

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