Collagenase clostridium histolyticum for Dupuytren's disease: a comprehensive systematic review and comparative analysis against percutaneous needle aponeurotomy and limited fasciectomy.

Abstract

This systematic review compared the efficacy of collagenase clostridium histolyticum (CCH) against percutaneous needle aponeurotomy (PNA) and limited fasciectomy (LF) for Dupuytren's contracture. Searches were conducted in PubMed, Embase, and Web of Science databases to March 2024. Randomised controlled trials (RCTs) were included. Primary outcomes included successful contracture correction as defined by included studies. Secondary outcomes included recurrence rates, patient-reported outcomes, and adverse events. A total of 11 studies (969 patients) were included. Meta-analysis showed no difference in efficacy between CCH and PNA (Relative Risk [RR]: 1.01, 95% Confidence Interval [CI]: 0.93-1.09). Recurrence rates were also similar (RR: 1.18, 95% CI: 0.95-1.48). Data suggested higher recurrence risk with CCH versus LF (RR: 6.84, 95% CI: 1.59-29.48). In some studies, CCH was associated with higher rates of haematoma, local pain, and oedema. CCH demonstrates comparable efficacy to PNA; however, it may have a higher risk of local complications and recurrence compared to LF. Treatment decisions should be made on a case-by-case basis.