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Treatment for adults with Dupuytren's
contracture with a palpable cord

Read these case studies to learn more about adult patients who present with Dupuytren's contracture with a palpable cord who may be appropriate for treatment with XIAFLEX®.

Review these profiles to learn more about patient types who were treated with XIAFLEX®

CONCURRENT TREATMENT OF 2 CORDS IN THE SAME HAND

Icon of a silhouette of a personPresentation

  • PETER, 64 years old
  • Engineer
  • 4-year history of Dupuytren's contracture on fifth finger and 3-year history on fourth finger
  • Previously untreated

Icon of a pair of scissorsAssessment

  • 40° MP contracture with a palpable cord on fourth finger
  • 50° MP contracture with a palpable cord on fifth finger

Icon of a medication bottleTreatment

  • 2 cords in same hand led physician to recommend XIAFLEX®
  • Physician administered 2 concurrent injections in 1 office visit to treat the 2 contractures
  • Physician performed finger extension procedures 3 days later

Icon of a clipboardOutcome

  • Fourth finger MP joint returned to 0° of normal; fifth finger MP joint returned to 5° of normal1
  • Experienced pain, ecchymosis, and edema in treated hand; each resolved within 1 week1
  • Following the finger extension procedure, patient was1:
    • Fit with a splint and provided instructions for use at bedtime for up to 4 months to maintain finger extension
    • Instructed to perform finger extension and flexion exercises several times a day for several months
    • Scheduled for follow-up visit in 30 days

1 or 2 joints with palpable cords on the same hand can be treated in 1 office visit.1

APPROPRIATE FOR A BROAD RANGE (20°–100°) OF MP CONTRACTURES1

Icon of a silhouette of a personPresentation

  • DONALD, 67 years old
  • Attorney
  • 5-year history of MP contracture on fourth finger of left hand
  • Contracture measured 20° at first visit with an HCP 4 years ago
  • His primary care physician suggested watchful waiting

Icon of a pair of scissorsAssessment

  • 40° MP contracture with a palpable cord on ring finger
  • Decreased range of motion

Icon of a medication bottleTreatment

  • Donald asked his specialist about XIAFLEX® because he did not want surgery

Icon of a clipboardOutcome

  • Finger returned to 0°–5° of normal after 1 treatment cycle1*†‡
  • Lymphadenopathy that resolved without medical intervention in approximately 2 weeks1
  • Following the finger extension procedure, patient was1:
    • Fit with a splint and provided instructions for use at bedtime for up to 4 months to maintain finger extension
    • Instructed to perform finger extension and flexion exercises several times a day for several months
    • Scheduled for follow-up visit in 30 days

Help treat a broad range of contractures now, while preserving your surgical options.1,4-6

  • Patients may have received up to 3 injections of study medication into the cords associated with contracture of the primary joints on Days 0, 30, and 60. Assessments were made 30 days after the last injection (on Days 30, 60, or 90).1
  • XIAFLEX®-treated patients received a mean of 1.7 injections in the 90-day controlled period in each clinical trial.1
  • One treatment cycle is injection of palpable cord with finger extension ~24–72 hours later. Injection and finger extension may be performed up to 3 times per cord at approximately 30-day intervals, if needed.1

Appropriate FOR A BROAD RANGE (20°–80°) OF PIP CONTRACTURES1*

Icon of a silhouette of a personPresentation

  • ELLEN, 56 years old
  • Office manager
  • 2-year history of PIP contracture on fifth finger of left hand
  • Previously untreated

Icon of a pair of scissorsAssessment

  • Approximately 45° PIP contracture with a palpable cord and significant progression in recent months
  • Decreased range of motion

Icon of a medication bottleTreatment

  • Surgeon and patient agreed on XIAFLEX® as course of treatment
  • When injecting a cord affecting a PIP joint of the fifth finger, the needle insertion should be no more than 2 to 3 mm in depth and avoid injecting more than 4 mm distal to the palmar digital crease1

Icon of a clipboardOutcome

  • Approximately 45° improvement in range of motion after 1 treatment cycle with XIAFLEX®1*†‡
  • Experienced mild contusion, pruritus, and tenderness at injection site; each resolved without medical intervention by the 30-day follow-up visit1
  • Following the finger extension procedure, patient was1:
    • Fit with a splint and provided instructions for use at bedtime for up to 4 months to maintain finger extension
    • Instructed to perform finger extension and flexion exercises several times a day for several months
    • Scheduled for follow-up visit in 30 days

In 2 clinical studies, patients with PIP contractures experienced 28° and 32° mean improvement in range of motion after treatment with XIAFLEX® vs 5° and 7° with placebo.1*

  • Patients may have received up to 3 injections of study medication into the cords associated with contracture of the primary joints on Days 0, 30, and 60. Assessments were made 30 days after the last injection (on Days 30, 60, or 90).1
  • XIAFLEX®-treated patients received a mean of 1.7 injections in the 90-day controlled period in each clinical trial.1
  • One treatment cycle is injection of palpable cord with finger extension ~24–72 hours later. Injection and finger extension may be performed up to 3 times per cord at approximately 30-day intervals, if needed.1

ADULT PATIENTS WHO PREFER NOT TO UNDERGO SURGERY MAY BE VIABLE CANDIDATES FOR XIAFLEX®4

Icon of a silhouette of a personPresentation

  • LARRY, 55 years old
  • Physician
  • 3-year history of MP contracture on third finger of right hand
  • Previously untreated

Icon of a pair of scissorsAssessment

  • 45° MP contracture with a palpable cord and significant progression in recent months
  • 10° MP contracture with a palpable cord of fourth finger not to be treated at this time
  • Decreased range of motion time

Icon of a medication bottleTreatment

  • Prefers not to undergo surgery
  • Larry’s surgeon adopted XIAFLEX® as the treatment course considering the risk/benefit ratio for Larry

Icon of a clipboardOutcome

  • Finger returned to 0°–5° of normal after 1 treatment cycle1*†‡
  • Experienced contusion and injection site swelling in treated hand1
  • Following the finger extension procedure, patient was1:
    • Fit with a splint and provided instructions for use at bedtime for up to 4 months to maintain finger extension
    • Instructed to perform finger extension and flexion exercises several times a day for several months
    • Scheduled for follow-up visit in 30 days

XIAFLEX® is the only FDA-approved treatment option for adults with Dupuytren’s contracture with a palpable cord that can be performed in your office.1

  • Patients may have received up to 3 injections of study medication into the cords associated with contracture of the primary joints on Days 0, 30, and 60. Assessments were made 30 days after the last injection (on Days 30, 60, or 90).1
  • XIAFLEX®-treated patients received a mean of 1.7 injections in the 90-day controlled period in each clinical trial.1
  • One treatment cycle is injection of palpable cord with finger extension ~24–72 hours later. Injection and finger extension may be performed up to 3 times per cord at approximately 30-day intervals, if needed.1

PATIENTS WITH 2 JOINTS WITH PALPABLE CORDS MAY BE INJECTED SEQUENTIALLY IN APPROXIMATELY 4-WEEK INTERVALS1

Icon of a silhouette of a personPresentation

  • JACK, 50 years old
  • Truck driver
  • 3-year history of PIP contracture on fifth finger of left hand
  • 1.5-year history of PIP contracture on fourth finger of left hand
  • Previously untreated

Icon of a pair of scissorsFirst assessment

  • 75° PIP contracture with a palpable cord on fifth finger of left hand
  • 25° PIP contracture with a palpable cord on fourth finger of left hand
  • Decreased range of motion

Icon of a medication bottleTreatment

  • Patient's 75° PIP contracture on fifth finger of left hand to be injected first
  • When injecting a cord affecting a PIP joint of the fifth finger, the needle insertion should be no more than 2 to 3 mm in depth and avoid injecting more than 4 mm distal to the palmar digital crease1

Icon of a clipboardOutcome of first treatment

  • First joint returned to 0°–5° of normal after 1 treatment cycle1*†‡
  • Experienced a skin tear1
  • After disruption of 75° PIP contracture, patient's 25° PIP contracture was scheduled approximately 4 weeks later or when the skin tear had properly healed
  • Following the finger extension procedure, patient was1:
    • Instructed on proper care of skin tear by physician

Jack's follow-up assessments

Icon of a pair of scissors17-day assessment

  • Jack's skin tear found to be healing well with no sign of infection
  • Improved range of motion for this joint vs baseline1

Icon of a pair of scissors30-day assessment

  • Jack's skin tear found to be fully healed, and success of first injection on patient's 75° PIP contracture was determined
  • Improved range of motion for this joint
  • Jack's 25° PIP contracture to be treated

Icon of a medication bottleTreatment

  • XIAFLEX® injected into 25° PIP contracture on fourth finger of left hand
  • When injecting a cord affecting a PIP joint of the fifth finger, the needle insertion should be no more than 2 to 3 mm in depth and avoid injecting more than 4 mm distal to the palmar digital crease1

Icon of a clipboardOutcome of second treatment

  • Second joint returned to 0°—5° of normal after 1 treatment cycle1*†‡
  • Experienced contusion and tenderness in treated hand with resolution in approximately 1 week1
  • Following the finger extension procedure, patient was1:
    • Fit with a splint and provided instructions for use at bedtime for up to 4 months to maintain finger extension
    • Instructed to perform finger extension and flexion exercises several times a day for several months
    • Scheduled for follow-up visit in 30 days

If your patient has more than 1 palpable cord, XIAFLEX® can be considered for sequential treatment.1

  • Patients may have received up to 3 injections of study medication into the cords associated with contracture of the primary joints on Days 0, 30, and 60. Assessments were made 30 days after the last injection (on Days 30, 60, or 90).1
  • XIAFLEX®-treated patients received a mean of 1.7 injections in the 90-day controlled period in each clinical trial.1
  • One treatment cycle is injection of palpable cord with finger extension ~24–72 hours later. Injection and finger extension may be performed up to 3 times per cord at approximately 30-day intervals, if needed.1
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Important Safety Information for XIAFLEX®

  • XIAFLEX® is contraindicated in patients with a history of hypersensitivity to XIAFLEX® or to collagenase used in any other therapeutic application or application method
  • In the controlled and uncontrolled portions of clinical trials in Dupuytren's contracture, flexor tendon ruptures occurred after XIAFLEX® injection. Injection of XIAFLEX® into collagen-containing structures such as tendons or ligaments of the hand may result in damage to those structures and possible permanent injury such as tendon rupture or ligament damage. Therefore, XIAFLEX® should be injected only into the collagen cord with a MP or PIP joint contracture, and care should be taken to avoid injecting into tendons, nerves, blood vessels, or other collagen-containing structures of the hand. When injecting a cord affecting a PIP joint of the fifth finger, the needle insertion should not be more than 2 to 3 mm in depth and avoid injecting more than 4 mm distal to the palmar digital crease
  • Other XIAFLEX®-associated serious local adverse reactions in the controlled and uncontrolled portions of the studies included pulley rupture, ligament injury, complex regional pain syndrome (CRPS), sensory abnormality of the hand, and skin laceration (tear). In a historically controlled post-marketing trial, the incidence of skin laceration (22%) was higher for subjects treated with two concurrent injections of XIAFLEX® compared with subjects treated with up to three single injections in the placebo-controlled premarketing trials (9%). Cases of skin laceration requiring skin graft after finger extension procedures have been reported post-marketing. Signs or symptoms that may reflect serious injury to the injected finger/hand should be promptly evaluated because surgical intervention may be required
  • In the controlled portions of the clinical trials in Dupuytren's contracture, a greater proportion of XIAFLEX®-treated patients (15%) compared to placebo-treated patients (1%) had mild allergic reactions (pruritus) after up to 3 injections. The incidence of XIAFLEX®-associated pruritus increased after more XIAFLEX® injections in patients with Dupuytren's contracture
  • Because XIAFLEX® contains foreign proteins, severe allergic reactions to XIAFLEX® can occur. Anaphylaxis was reported in a post-marketing clinical study in one patient who had previous exposure to XIAFLEX® for the treatment of Dupuytren's contracture. Healthcare providers should be prepared to address severe allergic reactions following XIAFLEX® injections
  • In the XIAFLEX® trials in Dupuytren's contracture, 70% and 38% of XIAFLEX®-treated patients developed an ecchymosis/contusion or an injection site hemorrhage, respectively. Patients with abnormal coagulation (except for patients taking low-dose aspirin, eg, up to 150 mg per day) were excluded from participating in these studies. Therefore, the efficacy and safety of XIAFLEX® in patients receiving anticoagulant medications (other than low-dose aspirin, eg, up to 150 mg per day) within 7 days prior to XIAFLEX® administration is not known. In addition, it is recommended to avoid use of XIAFLEX® in patients with coagulation disorders, including patients receiving concomitant anticoagulants (except for low-dose aspirin)
  • In the XIAFLEX® clinical trials for Dupuytren's contracture, the most common adverse reactions reported in ≥25% of patients treated with XIAFLEX® and at an incidence greater than placebo were edema peripheral (eg, swelling of the injected hand), contusion, injection site hemorrhage, injection site reaction, and pain in the injected extremity

INDICATION

XIAFLEX® is indicated for the treatment of adult patients with Dupuytren's contracture with a palpable cord.

Please see the full Prescribing Information, including Medication Guide.

References:

1.  XIAFLEX® [package insert]. Malvern, PA: Endo Pharmaceuticals Inc.
2.  Starkweather KD, Lattuga S, Hurst LC, et al. Collagenase in the treatment of Dupuytren’s disease: an in vitro study. J Hand Surg Am. 1996;21(3):490-495.
3.  Data on file. DOF-XDC-18. Endo Pharmaceuticals Inc; July 24, 2015.
4.  Desai SS, Hentz VR. The treatment of Dupuytren disease. J Hand Surg Am. 2011;36(5):936-942.
5.  Brandt KE. An evidence-based approach to Dupuytren’s contracture. Plast Reconstr Surg. 2010;126(6):2210-2215.
6.  Hay DC, Louie DL, Earp BE, Kaplan FT, Akelman E, Blazar PE. Surgical findings in the treatment of Dupuytren’s disease after initial treatment with clostridial collagenase (Xiaflex). J Hand Surg Eur Vol. 2014;39(5):463-465.