DETECT (collagenase vs. surgery)
Trial question
Is surgery superior to collagenase injection in patients with Dupuytren's contracture?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
17.0% female
83.0% male
N = 201
201 patients (35 female, 166 male)
Inclusion criteria: patients with untreated Dupuytren's contracture
Key exclusion criteria: recurrent contracture; neurologic condition affecting finger function; contraindication for collagenase; pregnancy or lactation; contracture > 135 degree; rheumatoid arthritis
Interventions
N=101 collagenase injection (injection of collagenase clostridium histolyticum (0.58 mg) into the cord without local anesthesia, followed by manipulation of the finger to extension under local anesthesia 1-3 days later; repeat injections up to 3 times)
N=100 limited fasciectomy (exposing and excising the cord limiting the extension through a longitudinal zigzag incision)
Primary outcome
Success rate at 3 months
73
71
73.0 %
54.8 %
36.5 %
18.3 %
0.0 %
Collagenase
injection
Limited
fasciectomy
No significant
difference ↔
No significant difference in success rate at 3 months (73% vs. 71%; AD 2%, 95% CI -0.38 to 4.38)
Secondary outcomes
Significant decrease in success rate at 2 years (65% vs. 78%; ARD -0.13, 95% CI -0.26 to -0.01)
Significant decrease in reaching Patient Acceptable Symptom State at 2 years (76% vs. 90%; ARD -0.12, 95% CI -0.22 to -0.01)
No significant difference in > 50% release at 2 years (73% vs. 80%; ARD -0.09, 95% CI -0.2 to 0.03)
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In patients with untreated Dupuytren's contracture, collagenase injection was not superior to limited fasciectomy with respect to success rate at 3 months.
Reference
Mikko Petteri Räisänen, Olli V Leppänen, Janne Soikkeli et al. Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture : A Randomized Controlled Trial. Ann Intern Med. 2024 Mar;177(3):280-290.
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