Collagenase clostridium histolyticum
Collagenase clostridium histolyticum (CCH) is an enzyme marketed by Sobi under the name of Xiapex in the UK and by Pfizer as Xiaflex in the USA. From October 2014 it has been approved by the FDA in the USA for use in two cords at the same time.
The National Institute for Health and Clinical Excellence (NICE) has not yet issued guidance to the NHS in England, Wales, Scotland and Northern Ireland for the use of collagenase, although the treatment is under review. However the Scottish Medical Consortium has accepted restricted use of Xiapex in the NHS; the All Wales Medicines Strategy Group has approved the use of Xiapex for treatment within the NHS Wales; NHS Devon has also conditionally approved the use of Xiapex on the NHS, and the North East Treatment Advisory Group has recommended limited use of Xiapex on the NHS. Some other Regional Authorities or Trusts provide Xiapex on the NHS, including Birmingham, Derby, Wrightington, Wigan and Leigh, so you should check the availability where you live.
The NHS in Cambridgeshire and Peterborough have currently (2012) rejected the use of Xiapex, mainly on economic grounds and because there is no clinical trial data comparing Xiapex with established treatments such as surgery. (The main trials evaluating Collagenase compared it to injecting a placebo, not to surgery.) If such trials are done, then the case for Xiapex will be reconsidered.
In 2013 NICE started and appraisal process to evaluate the technology of using Collagenase, to decide if it should be made available on the NHS in the whole of England. The final decision is expected late 2016 or early 2017.
The distributors of Xiapex have an informative website that is worth looking at.
Collagenase Clostridium Histolyticum can be injected into the cord that has formed in the palm of your hand. The medicine contains special proteins that can break up the collagen fibres in the cord. This weakens the cord, eventually allowing the bent finger(s) to be straightened.
The injection is normally done on outpatient basis. The doctor may mark the site for the injections so that the enzyme is injected into the cords, avoiding tendons, nerves and other important structures. The injection has been described as feeling like a bee sting.
You return to the doctor 24 hours or more after the injection (up to a week sometimes), when under a local anaesthetic, the bent finger(s) are physically straightened and held stretched out for 10 to 20 seconds. This disrupts the strands in the cords and breaks the cord and should increase the range of movement in your bent finger.
You should not attempt to straighten your finger yourself within the first 24 hours, or squeeze or press the cord. Keeping your finger bent encourages the injected medicine to stay in the cord which is where it needs to be.
If the first injection is not effective, you can have up to three injections in the same cord, with one month between injections.
In one study looking into Collagenase Clostridium Histolyticum, nearly two thirds of people could almost completely straighten their finger after the injections.
The patient leaflet for Xiapex lists considerations when caution must be taken for using this treatment:
- known allergy to the ingredients. There is a risk of anaphylactic shock that the surgeon must be prepared for.
- problems with blood clotting
- taking anti-coagulants
- under age 18
The most common side effects occur around the site of the injection. These include:
These should improve within a week or two. Less common side effects include feeling sick or dizzy, lumps in the glands under your arm, and there have been reports of new Dupuytren’s nodules flaring up.
Collagenase Clostridium Histolyticum is still a very new treatment. There are examples of results from short-term studies, but the long-term recurrence times or rates are unknown.
Our treatment links page lists some UK surgeons who have experience treating Dupuytren’s.
Patient and doctor experiences
For more information see the videos linked to here.