Date of Award

2015

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not collagenase clostridium histolyticum is a safe and effective treatment for adult patients with Dupuytren’s contracture.

STUDY DESIGN: Review of two double-blind, placebo-controlled randomized controlled trials and one cross-sectional study. All of these studies are published in English between 2009-2013.

DATA SOURCES: Two double-blind, placebo-controlled randomized controlled trials and one cross-sectional study found using PubMed.

OUTCOMES MEASURED: Each randomized controlled trial measured the ability to meet the primary end point and all secondary endpoints, percent decrease in degree of contracture, increase in range of motion, patient satisfaction, and recording of adverse events which played a significant role in patient quality of life.

RESULTS: Hurst et al and Gilpin et al showed a significant increase in range of motion and decrease in the flexion contracture after the use of collagenase clostridium histolyticum compared to the placebo. The NNT for Hurst et al was 2 while the NNT for Gilpin et al was 3. There were significantly more adverse effects in the collagenase group than placebo group such as contusion and injection site hemorrhage or pain. Hay et al found surgery was made more difficult in 4 out of 15 (26.7%) cases compared to the other 11 out of 15 (73.3%) cases in which surgery was not made more difficult.

CONCLUSIONS: Based on these three studies, collagenase clostridium histolyticum is a safe and effective treatment for adults with Dupuytren’s contracture. The studies exhibited significant improvement in range of motion and decreasing the flexion contractures involved in Dupuytren’s.

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