Dupuytren's Contracture now treated with shots rather than surgery
MAYWOOD, Ill. -- Loyola University Health System is one of first centers in the U.S. to offer a new, nonsurgical treatment for Dupuytren's contracture, a debilitating condition that curls fingers toward the palm.
Dupuytren's contracture affects one or more fingers, usually the little finger and ring finger. Growth of a cord of tissue under the skin causes the finger to bend inward so that the finger cannot be straightened.
The traditional treatment is outpatient surgery to remove the tissue, said Loyola hand surgeon Dr. Randy Bindra. The patient has stitches for 10 to 14 days and needs to do physical therapy. It takes one to three months before the fingers become fully flexible.
The new drug is Xiaflex® (collagenase clostridium histolyticum). In an outpatient clinic, a doctor injects the drug into a Dupuytren's cord that is causing the finger to bend. The drug contains enzymes that break down collagen, one of the main components of the cord.
The patient returns to the clinic the next day and the physician gently extends the finger to break the cord. "The patient feels a pop and the finger opens up," Bindra said. No physical therapy is needed.
The treatment worked well for James Santo, 83, of Chicago. Santo had Dupuytren's contracture on the little finger of his right hand. His finger curled so much the tip touched the palm of his hand.
Bindra administered one injection. Santo said it felt like an ordinary shot and he experienced no pain afterward.
Santo can now extend his finger until it is nearly straight. "It's normal now," he said.
A study of 306 Dupuytren's contracture patients found that 64 percent had a straight or nearly straight hand after one to three injections of the drug, compared with 7 percent who received a placebo. The Food and Drug Administration, which approved the drug, called it "an important advance in the management of this disabling condition."
Bindra said the injections must be carefully administered because the drug can dissolve collagen in healthy skin and tendons. If injected in the wrong spot, the drug can snap a tendon and leave the patient unable to close the finger. As a hand surgeon who has done more than 100 surgeries for Dupuytren's contracture, Bindra knows exactly where to inject the drug.
The Food and Drug Administration said the drug should be administered only by a health-care professional experienced with hand anatomy because tendon ruptures can occur.
The most common adverse reactions to the drug are fluid buildup, swelling, bleeding and pain in the injected area, the FDA said.
Bindra said the drug does not necessarily cure the condition. In some patients, the abnormal tissue grows back and curls the finger, requiring further treatment.
Dupuytren's contracture often runs in families. It is more common in men, especially those of northern European descent. Other risk factors include increasing age and certain medical conditions, such as diabetes and seizures.
Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 569-licensed-bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children’s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 264-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.