Collagenase clostridium histolyticumRx

Trade Names: Xiaflex

Synonyms: Collagenase; CCH

Drug Class: Enzyme

Preparations:  Lyophilized powder containing 0.9 mg of collagenase in a single use vial

Dose: For Dupuytren’s contracture: 0.58 mg injected into a Dupuytren’s contracture cord affecting an MCP or PIP joint. Perform dilution, injection and follow up (including a finger extension procedure if required, and splinting) according to the manufacturer’s instructions. Only one cord injected at a time. Re-injection may be required.

Indications: Dupuytren’s contracture with a palpable cord, Peyronie’s disease

Mechanism of Action: Collagenase lyzes collagen disrupting the Dupuytren’s contracture cord

Contraindications: Hypersensitivity to collagenase

Precautions: Injection into tendons can cause tendon rupture.  Increased risk of bleeding with anticoagulants.

Pregnancy Risk: B

Adverse Effects
Common: Injection site swelling and bruising (70%), pain (35%), itching, lymphadenopathy
Less common: Skin splitting open, injection site bleeding
Rare: Anaphylaxis, tendon rupture, nerve damage

Drug Interactions:
Anticoagulants: Avoid concurrent use  (increased risk of bleeding)

Patient Instructions: Swelling and bruising common after injection. Some people are allergic to the drug.

Comments: In clinical trials 64% of cords injected had reduction in contracture to 0-5 degrees after 30 days compared to 7% in placebo.  In cords that responded well, approximately 35%  recurred within 3 years (defined as 20 degree or worse contracture and palpable cord). In patients with cords that were partial responders initially, the recurrence rate was higher. Cords affecting PIP joints have a lower initial response and a higher recurrence rate than those affecting MCPs.

Clinical Pharmacology: No quantifiable serum levels after injection in patients with Dupuytren’s contracture.

Cost: $$$$$

BIBLIOGRAPHY

Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA, Smith TM, Rodzvilla J; CORD I Study Group. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med 2009;361:968-79. PMID: 19726771.

Peimer CA, Blazar P, Coleman S, Kaplan FT, Smith T, Tursi JP, Cohen B, Kaufman GJ, Lindau T. Dupuytren contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS study): 3-year data. J Hand Surg Am 2013;38:12-22. PMID: 23200951.