Dupuytren’s contracture in patients with a palpable cord
(specialist use only)
▶BY INTRALESIONAL INJECTION
▶Adult: 580 micrograms, then 580 micrograms every
4 weeks if required, inject into palpable cord, up to 2
cords or 2 affected joints in the same hand may be
treated at a time. Maximum 3 injections per cord,
maximum 8 injections in total
Peyronie’s disease (specialist use only)
▶BY INTRALESIONAL INJECTION
▶Adult: 580 micrograms, then 580 micrograms after
1–3 days, doses to be administered into the Peyronie’s
plaque; if more than one plaque is present, only the
plaque causing the deformity should be injected, a
treatment course consists of a maximum of 4 treatment
cycles, administered at intervals of approximately
6 weeks. Each treatment cycle consists of 2 injections
and 1 penile modelling procedure; the modelling
procedure is performed 1–3 days after the second
injection of each treatment cycle
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Avoid injecting into other
structures containing collagen (e.g. tendons, nerves, blood
vessels, urethra and corpora cavernosa)—risk of injury
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GENERAL CAUTIONS Coagulation disorders. use of
anticoagulants
SPECIFIC CAUTIONS
▶When used for dupuytren’s contracture bone fragility (risk of
fracture during manipulation). reduced peripheral
circulation (risk of finger necrosis)
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NICE decisions
▶Collagenase clostridium histolyticum for treating Dupuytren’s
contracture (July 2017) NICE TA459
For people not taking part in the ongoing clinical trial
(HTA-15/102/04), collagenase clostridium histolyticum
(Xiapex ®) is recommended as an option for treating
Dupuytren’s contracture with a palpable cord in patients
only if the following apply:
. There is evidence of moderate disease (functional
problems and metacarpophalangeal joint contracture of
30° to 60° and proximal interphalangeal joint
contracture of less than 30° or first web contracture) plus
up to 2 affected joints, and
. Percutaneous needle fasciotomy is not considered
appropriate, but limited fasciectomy is considered
appropriate by the treating hand surgeon, and
. The choice of treatment (collagenase clostridium
histolyticum or limited fasciectomy) is made on an
individual basis after discussion between the responsible
hand surgeon and the patient about the risks and
benefits of the treatments available, and
. One injection is given per treatment session by a hand
surgeon in an outpatient setting.
Patients whose treatment was started within the NHS
before this guidance was published should have the option
to continue treatment, without change to their funding
arrangements, until they and their NHS clinician consider
it appropriate to stop.
www.nice.org.uk/guidance/ta459
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