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Background: Collagenase Clostridium histolyticum (CCH) injection, an effective enzymatic fasciotomy treatment for Dupuytren disease (DD), was abruptly withdrawn from the healthcare market outside the United States in 2020. The impact on patients, physicians and hospitals of this helpful surgical alternative no longer being available has been little studied., Methods: To investigate the impact of the withdrawal of CCH in Japan, we used the National Database Open Data Japan from 2014 to 2020. Published by the government, it contains summary data of the National Database of Health Insurance Claims and Specific Health Checkups of Japan. We extracted the numbers of CCH injections with Xiaflex, the product name in Japan, and surgeries identified by "Dupuytren contracture surgery codes." Each treatment was further parsed into one of 12 predefined regions in which it had taken place and by whether it had been delivered on an inpatient or outpatient basis., Results: From its introduction in 2015, the number of DD patients treated with CCH increased in each successive year, reaching a peak in 2019, while the number of surgeries decreased with time. After the withdrawal in 2020, the number of surgeries increased to 1.5 times the 2019 number notwithstanding the impact of COVID-19, but the total number of patients treated decreased by 43%. In the initial regional analysis, CCH accounted for approximately 40% of all DD treatments in the less populous areas, with the exception of the Tohoku region, and more than 50% in the other regions. By 2019, the share of CCH treatment had increased in all regions. There was no significant correlation between the number of hand surgeons authorized to use CCH and the number of CCH cases within each region., Conclusions: CCH increased treatment options for patients and surgeons. The withdrawal of this valuable pharmaceutical resulted in an increase in the number of surgeries amidst a decrease in the total number of treatments and lost opportunities for patients., Competing Interests: Conflicts of interest and sources of funding: This work was supported by JSPS (Japan Society for the Promotion of Science) KAKENHI Grant Number 21H03288., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Treatment with injection of collagenase Clostridium histolyticum (CCH) has been recognized as an effective option for the Dupuytren's contracture (DC) in Europe and North America. However, there are no studies describing mid-term efficacy of CCH treatment in East-Asian population. The purpose of this study was to assess 2-year outcomes following CCH treatment in Japanese patients., Methods: Twenty hands (28 joints) from 18 DC patients underwent CCH injection with manipulation according to the product specifications with 2-year follow-up. Patients were assessed for extension deficit on treated metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints before treatment, at 4 weeks and 2 years after the treatment., Results: At 4 weeks after CCH treatment, contracture of treated joints significantly improved from the mean extension deficit of 45° before treatment to 3° for MCP joints, and from 41° to 14° for PIP joints (P < 0.001, <0.001, respectively). Improved contracture was maintained with 4° and 23° at 2 years after CCH treatment (P < 0.001, <0.05, respectively). Successful correction defined as ≤ 5° extension deficit was obtained in 14/16 MCP and 5/12 PIP joints at 4 weeks; of these, 11 MCP and 1 PIP joints maintained the corrected range of motion at 2-year follow-up., Conclusion: CCH treatment could be a useful option to improve contracture in Japanese patients. During 2-year follow-up, this treatment could provide comparable effect durability to previous studies from Western countries. Moreover, our results support the evidence that better correction of the contracture can be obtained in the MCP joints than PIP joints after CCH treatment., (Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)