Non Surgical treatments for Dupuytrens

Collagenase, Xiaflex, Enzyme injections

These are all terms for the same thing.  Xiaflex is the trade name used by Auxilium in the USA for their injectable enzyme treatment for Dupuytrens.  The product is licenced by Pfizer for the European market and is going through the regulatory approval process at the moment.  If all goes according to normal timetables then it should be licenced in Early 2010.

Collagen is the basic building block of the body.  All the various bits of you are held together by various forms of collagen.  There are over 20 different types described and more are discovered regularly.  In humans there are 5 important types.  Types I and III are involved in ligaments, tendons, scar tissue and, most importantly for us, Dupuytrens.  The different types of collagen are chemically quite different although they are still all types of collagen and this is important as you will see.

Collagen is pretty tough and there are very few things in nature that can chew up collagen but there are a group of bacteria called Clostridia which have evolved specific techniques to destroy collagen.  Clostridia Histolyticum in particular has developed a range of enzymes called collagenases which specifically digest collagen.  The collagenases come in various forms and companies can extract the specific collagenases for different types of collagen.  Auxilium therefore are able to isolate only those collagenases which digest Collagens type I and III.  There are two collagenase enzymes. One chops the ends off the collagen and the second then chops up the remaining bits into very tiny pieces, essentialy producing a sort of protein soup.

The procedure is to inject this enzyme mixture into the cord using a very precise technique and then to let the enzymes work for 24-48 hours.  At the end of that time the dupuytrens will have softened and the finger will simply pull straight.  The injection is no more painful than having a simple tetanus type jab.

I will update this page with more information as I can.  The important thing is that the injection is very successful.  In a recent trial 80% of patients got full correction of their contracture.

Splints

Splints have not been shown to be of any benefit in slowing down the progression of Dupuytrens and may be counter productive.  There is increasing evidence that splints may actually be detrimental even after surgery and this whole area is changing rapidly.

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