Collagenase clostridium histolyticum: a novel nonoperative treatment for Dupuytren’s disease

Collagenase clostridium histolyticum has demonstrated safety and efficacy in the treatment of metacarpophalangeal and proximal interphalangeal joint contractures in Dupuytren’s disease as a 0.58-mg dose delivered via direct injection into the Dupuytren’s cord. Extension is achieved via manual manipulation 24 h following injection. Commercially available collagenase clostridium histolyticum is a combination of class I and class II collagenases that act in concert to degrade the type I and type III collagen content of pathologic Dupuytren’s cords and is available to practitioners who have completed focused training in injection technique. This article reviews collagenase clostridium histolyticum pharmacodynamics as well as the basic science and clinical studies resulting in US FDA and EMA approval for the treatment of Dupuytren’s disease. Clinical indications, technique and an analysis of future indications are reviewed.