IQVIA, Falls Church, VA, USA.
Endo Pharmaceuticals Inc., Malvern, PA, USA.
Hand (N Y). 2022 May;17(3):491-498. doi: 10.1177/1558944720919923. Epub 2020 Jun 7.
Dupuytren contracture (DC) treatment with collagenase clostridium histolyticum (CCH) has lower associated treatment costs than fasciectomy, but real-world, postprocedure return-to-function data are limited. This retrospective study used a US claims database and included adults treated for DC with CCH or fasciectomy (first treatment = index date), who had continuous health plan enrollment ≥360 days preindex and ≥90 days postindex (ie, 90-day follow-up). Analgesic use and physical therapy (PT) and occupational therapy (OT) visits during the follow-up were used as surrogate markers for return-to-function. Overall, 1654 and 2745 patients were included in the CCH and fasciectomy cohorts, respectively. A significantly lower percentage of patients in the CCH versus fasciectomy cohort used opioid analgesics (32.3% vs 82.7%; < .0001), used nonsteroidal anti-inflammatory drugs (8.6% vs 17.2%; < .0001), or had ≥1 DC-specific PT or OT visit during follow-up (PT, 38.9% vs 45.3% [ < .0001]; OT, 32.8% vs 38.0% [ = .0006]). The mean number of DC-specific PT and OT visits (PT, 2.5 vs 6.4 [ < .0001]; OT, 1.4 vs 1.9 [ < .0001]) per patient was significantly lower in the CCH versus fasciectomy cohort. This analysis using surrogate markers suggests that CCH treatment may allow earlier return-to-function than fasciectomy in adults treated for DC.
这项回顾性研究使用了美国的索赔数据库,纳入了接受 CCH 或筋膜切除术治疗掌腱膜挛缩症的成年人(首次治疗=索引日期),他们在索引前 360 天和索引后 90 天(即 90 天随访)内持续参加健康计划。在随访期间使用镇痛药的使用情况以及物理治疗(PT)和职业治疗(OT)就诊作为功能恢复的替代指标。
总体而言,CCH 和筋膜切除术队列分别纳入了 1654 例和 2745 例患者。与筋膜切除术组相比,CCH 组使用阿片类镇痛药(32.3%比 82.7%;<0.0001)、非甾体抗炎药(8.6%比 17.2%;<0.0001)或在随访期间接受≥1 次掌腱膜挛缩症特定的 PT 或 OT 就诊的患者比例显著更低(PT,38.9%比 45.3%[<0.0001];OT,32.8%比 38.0%[=0.0006])。与筋膜切除术组相比,CCH 组每位患者接受掌腱膜挛缩症特定的 PT 和 OT 就诊的平均次数(PT,2.5 比 6.4[<0.0001];OT,1.4 比 1.9[<0.0001])显著更低。
使用替代指标的这项分析表明,在接受掌腱膜挛缩症治疗的成年人中,CCH 治疗可能比筋膜切除术更早恢复功能。