CORD I (collagenase for Dupuytren)

Injectable collagenase clostridium histolyticum for Dupuytren's contracture

Hurst LC, Badalamente MA, Hentz VR, et al. The New England journal of medicine 2009 · PMID 19726771 · doi:10.1056/nejmoa0810866

Question

Is injectable collagenase effective at correcting Dupuytren's contracture compared with placebo?

Design

Multicentre double-blind placebo-controlled RCT in the USA.

Patients

Adults with Dupuytren's contracture of the MCP or PIP joint with a palpable cord.

Intervention

Collagenase clostridium histolyticum injection into the cord followed by finger extension manipulation (up to three injections)

Comparison

Placebo injection

Primary outcome

Reduction of contracture to within 0-5 degrees of full extension 30 days after last injection

Key result

Collagenase achieved the primary end point in significantly more joints than placebo, with better results at the MCP than the PIP joint; adverse events were mostly local (swelling, bruising, skin tears), with rare tendon rupture.

Limitations

Placebo rather than surgical comparator; short follow-up so recurrence was not addressed; industry funded.

Impact on practice

Led to licensing of collagenase and NICE approval (TA459) as an alternative to fasciectomy in selected patients; recurrence and availability have since limited its use in the UK.