clostridium histolyticum
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Landon Trost ◽  
Huan Huang ◽  
Xu Han ◽  
Chakkarin Burudpakdee ◽  
Yiqun Hu

AbstractCollagenase clostridium histolyticum (CCH) is an injectable therapy targeting collagen present in penile plaques in Peyronie’s disease (PD). Data comparing CCH to penile surgery are limited, and long-term therapeutic outcomes are unknown. This retrospective analysis used a US claims database (January 2014–June 2017) to determine the percentage of men with subsequent penile surgery among those who initially received CCH (n = 1227) or surgery (index treatment; n = 620) for PD. Eligible patients were aged ≥18 years with continuous enrollment ≥6 months before and ≥12 months after index treatment date. During 12 months of post-index treatment follow-up, fewer patients with PD initially treated with CCH (4.6% [56/1227]) had subsequent penile surgery versus those initially treated with penile surgery (10.3% [64/620]; p < 0.0001). Mean ± SD time to first subsequent surgery after initial PD treatment was longer in the CCH versus surgery cohort (7.7 ± 3.0 vs 1.7 ± 3.2 months). The likelihood of subsequent surgery varied by initial surgery type: 18.2% after plaque incision or excision with grafting; 11.6% after penile implant; and 8.2% after tunical plication. Patients with PD who received CCH first were less likely to undergo subsequent surgery compared with those who received surgery first within a 12-month post-treatment follow-up.

2021 ◽  
Vol 6 (4) ◽  
pp. 278-285
Putu Feryawan Meregawa ◽  
John Nolan

Dupuytren’s disease is a disorder of fibroproliferative condition causing thickened and contracted of the palmar fascia. The pathophysiology behind this disease is complex and multifactorial. Some major factors are genetic predisposition, inflammatory response, trauma, comorbidities, and environmental factors. The treatment options for Dupuytren’s disease are divided into non-surgical and surgical management. Needle fasciotomy and fasciectomy are some of the most common surgical procedures chosen. Novel non-surgical treatment option as the recent advance in the treatment of the disease is the injection of collagenase Clostridium histolyticum (CCH). One of the pitfalls of Dupuytren’s management is the high possibility of the disease’s recurrence along with some other post-intervention complications. Rehabilitation following the interventions is needed to manage the maximum range of motion and curtail the inflammatory response after the cord disruption. Keywords: Dupuytren’s disease, clostridium histolyticum, fasciectomy.

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110472
Hiroko Iwakawa ◽  
Shigeharu Uchiyama ◽  
Yasunari Fujinaga ◽  
Masanori Hayashi ◽  
Masatoshi Komatsu ◽  

Purpose We aimed to evaluate the extent of collagenase clostridium histolyticum (CCH) diffusion in Dupuytren’s contracture (DC) for tissues outside of the contracture cord using Magnetic Resonance Imaging (MRI) immediately after CCH injection. Methods: 10 male patients aged 57–79 with DC of the metacarpophalangeal (MCP) joints were examined. Extension deficits were 10–60°(mean, 34.3) and 0–60°(mean, 26.6) in the MCP and proximal interphalangeal (PIP) joints, respectively. CCH injection was performed according to the standard method. MRI was performed within 15 min of CCH injection. Results: In all 10 cases, the extended area of high-intensity signal change outside of the cord was observed on short-T1 inversion recovery images (STIRs). Continuity from the insertion site was observed in the area of signal change involving the flexor tendon and neurovascular bundle. The signal change area spanned distally and proximally beyond the injection level. The signal change area expanded along the tendon sheath but no signal changes were observed inside the flexor tendon, suggesting the tendon sheath serves as a protective barrier from the CCH solution. After 1 week of injection, the mean decrease in contracture was 32.5°(94.7%) for the MCP joint and 19.8°(74.4%) for the PIP joint. In nine out of 10 cases, the extension deficit was within five degrees of full extension in the affected finger. There was no neurovascular injury or tendon rupture at 3 months of observation. Conclusions: MRI indicated the possible leakage of the drug outside of the cord during the early phase after administration, suggesting that CCH could persistently affect healthy tissues until CCH inactivates its enzyme process.

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