DISC Non-Inferiority RCT: Collagenase Injection vs Limited Fasciectomy

Description

In this presentation, Joe Dias discusses a study conducted by the NIHR that compared two treatments for Dupuytren's contracture—a condition causing bent fingers that affects hand function. The study aimed to evaluate the effectiveness of standard surgical treatment (limited fasciectomy) against an alternative non-surgical treatment option, collagenase injections. Collagenase, an enzyme derived from clostridial bacteria, breaks down collagen in the affected cord and allows for manipulation to correct the contracture.



The study, involving 710 patients across the UK, randomly assigned participants to either fasciectomy or collagenase treatment. The primary endpoint was assessed after one year, with follow-ups at six months and two years to evaluate the outcomes, including hand function and recurrence rates.



The findings indicated that while both treatments provided initial benefits, over time, collagenase proved to be inferior to surgery in sustaining improvement and reducing re-operation rates. Collagenase patients experienced a noticeable decline in hand function and contracture improvement after two years. Although mild complications were more frequent in the collagenase group, severe complications were more common after surgery. Ultimately, the study concluded that while the collagenase injections are less invasive, their long-term effectiveness does not match that of surgical intervention.

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