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• Dupuytren's Interventions: Surgery vs Collagenase

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DISC - Collagenase injection versus limited fasciectomy surgery to treat Dupuytren’s contracture in adult patients in the UK: a noninferiority RCT and economic evaluation

There was limited robust evidence comparing surgical correction and collagenase injection for the corrections of Dupuytren’s Contracture (DC). We conducted a UK-wide multicentre randomised controlled trial (RCT) to assess the clinical effectiveness, cost- effectiveness, and patient’s experiences with the condition to address this. The study showed that among adults with Dupuytren’s contracture, collagenase delivered in an outpatient setting is less effective but more cost-saving than limited fasciectomy. 

Why did we do this research?

Dupuytren’s contracture is caused by nodules and cords which pull the fingers towards the palm of the hand. Treatments include limited fasciectomy surgery, collagenase injection and needle fasciotomy. There is limited evidence comparing limited fasciectomy with collagenase injection. The DISC Trial was designed to compare whether collagenase injection is not inferior to limited fasciectomy when treating Dupuytren’s contracture.

What did we do?

We undertook a pragmatic, two-arm, unblinded, randomised controlled non-inferiority trial with a cost-effectiveness evaluation. We also conducted a nested qualitative sub-study to assess patient preferences and a sub-study to assess the acceptability of patient-taken photos of their hand for remote review of DC.

Who was involved?

Patients with Dupuytren’s contracture of ≥ 30 degrees who had not received previous treatment in the same digit were eligible to participate in the DISC trial subject to confirmation by their NHS care teams. They were randomised to either limited fasciectomy surgery or collagenase injection (with manipulation of the finger 1–7 days later). Thirty-one NHS hospitals in England and Scotland recruited to the study. 

What did we find?

Among adults with Dupuytren’s contracture, collagenase delivered in an outpatient setting is less effective but more cost-saving than limited fasciectomy. More participants treated with collagenase reported preferring this in the future compared to LF participants preferring the same intervention again. Further research is required to establish the longer-term implications of both treatments Recurrence and re-intervention usually occur after 1 year, and therefore follow-up to 5 years or more could resolve whether the differences observed in the Dupuytren’s interventions surgery versus collagenase trial to 2 years worsen.

Publications

Dias J, Tharmanathan P, Arundel C, et al. Collagenase Injection versus Limited Fasciectomy for Dupuytren’s Contracture. N Engl J Med 2024;391:1499-1510. DOI: 10.1056/NEJMoa2312631.

Wu Q, Tharmanathan P, Arundel C, Welch C, Leighton P, Dias J, et al. The Cost-Effectiveness of Collagenase Injection versus Limited Fasciectomy for Moderate Dupuytren’s Contracture: An Economic Evaluation of the DISC Trial and a Decision Analytical Model. Value in Health. 2025;28. DOI:10.1016/j.jval.2025.07.030.

Dias J, Tharmanathan P, Arundel C, Welch C, Wu Q, Leighton P, et al. Collagenase injection versus limited fasciectomy surgery to treat Dupuytren's contracture in adult patients in the UK: DISC, a non-inferiority RCT and economic evaluation. Health Technol Assess. 2024;28(78). DOI:10.3310/KGXD8528.

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