14th May 2012
XIAPEX®? (COLLAGENASE CLOSTRIDIUM HISTOLYTICUM) RECOMMENDED FOR NHS USE IN SCOTLAND
Walton Oaks, 14th May 2012: NHS patients in Scotland will now have access to the first licensed injectable treatment option indicated for Dupuytren’s contracture, which has been recommended for restricted use by the Scottish Medicines Consortium (SMC).1
Xiapex (collagenase clostridium histolyticum) was launched in the UK in April 2011 to treat Dupuytren’s contracture in adult patients with a palpable cord (a cord you can feel or touch). Collagenase clostridium histolyticum offers an alternative treatment option to surgery for Dupuytren’s contracture.
Dupuytren’s disease is a condition of the hand and fingers which affects around two million people in the UK. A small number of those patients with Dupuytren’s disease will go on to develop Dupuytren’s contracture, whereby the affected finger permanently bends inwards into the palm of the hand. This condition can affect a person’s ability to carry out everyday tasks such as driving, washing or shaking hands.3
Henry Orton, Co-founder of the British Dupuytren’s Society said: “Dupuytren’s contracture can cause real problems for sufferers, having a huge impact on daily activities. We welcome the SMC’s decision to recommend collagenase clostridium histolyticum for NHS patients in Scotland, which will offer a long-awaited alternative to surgery in the treatment of this debilitating condition.”
The SMC recommends collagenase clostridium histolyticum for restricted use as an alternative to limited fasciectomy in adult patients with Dupuytren’s contracture of moderate severity (as defined by the British Society for Survey of the Hand (BSSH), with a palpable cord and up to two affected joints per hand who are suitable for limited fasciectomy, but for who percutaneous needle fasciotomy is not considered a suitable treatment option.
This positive recommendation follows a resubmission by Pfizer in January 2012. In August 2011, the SMC gave a negative recommendation for the use of collagenase clostridium histolyticum within its licensed indication and up to two affected joints per hand as a substitute for established surgical interventions.
Mark Broadbent, Consultant Trauma and Orthopaedic Surgeon at Inverclyde Royal Hospital, welcomes the news: “This positive recommendation is great news for patients in Scotland suffering from Dupuytren’s contracture. I am pleased that patients with this condition will now be able to benefit from access to a clinically effective alternative to surgery.”
Collagenase clostridium histolyticum has also received positive appraisals from commissioning bodies in the North East of England and Wales.
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Notes to Editors
About the Scottish Medicines Consortium’s (SMC) recommendation for Xiapex (collagenase clostridium histolyticum)
The SMC recommends collagenase clostridium histolyticum as an alternative to limited fasciectomy in adult patients with Dupuytren’s contracture of moderate severity (as defined by the British Society for Surgery of the Hand (BSSH)) with a palpable cord and up to two affected joints per hand, who are suitable for limited fasciectomy, but for whom percutaneous needle fasciotomy is not considered a suitable treatment option.1
Details of the SMC recommendation for collagenase clostridium histolyticum can be viewed here.
The SMC is made up of lead clinicians, pharmacists and health economists together with representatives of health boards, the pharmaceutical industry and the public to make recommendations on the commissioning of newly licensed medicines within Scotland. The SMC analyses information supplied by the drug manufacturer on the health benefits of the drug and justification of its price. The SMC works to make sure that those drugs, which represent cost effectiveness, are accepted for routine use so that they can benefit patients. 
About Dupuytren’s disease
Dupuytren’s disease is a slowly progressive condition affecting up to two million people in the UK.3 The condition affects the layer of connective tissue in the palm of the hand and the fingers (the palmar fascia).  Dupuytren’s disease starts in the palm of the hand with the appearance of a number of nodules, made of cells that can produce collagen.5 As the disease progresses, excess collagen continues to build up and may eventually form into a rope-like cord under the skin.5 The cord extends from the palm into the finger and can gradually contract the finger permanently toward the palm; this is known as Dupuytren’s contracture.5 A small number of those patients with Dupuytren’s disease will go on to develop Dupuytren’s contracture.
Whilst the true cause of the Dupuytren’s disease is largely unknown, studies suggest that up to 70% of people with Dupuytren’s disease have a family history of the condition.5 Dupuytren’s disease is found more frequently in people of white northern European descent5 and the highest prevalence has been seen in northern Scotland, Iceland and Norway., The condition is also more common in men who tend to be more severely affected by Dupuytren’s disease than female patients.
Dupuytren’s disease is very uncommon in the teens and twenties but the incidence rises in each decade thereafter. Consequently it can be expected that as the ageing population increases, so does the incidence of Dupuytren’s disease. The estimated prevalence rates of Dupuytren’s disease is up to 20% of men who are over 60 years of age, and 20% of women who are over 80 years of age.5
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 Scottish Medicines consortium advice 2012 http://www.scottishmedicines.org.uk/SMC_Advice/Advice/715_11_collagenase_clostridium_histolyticum_Xiapex/collagenase_Xiapex_RESUBMISSION
 Xiapex SmPC. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002048/WC500103373.pdf Last accessed: 23.03.12
 Townley WA, et al. Dupuytren’s contracture unfolded. BMJ 2006; 332: 397-400
 Scottish Medicines consortium. Who we Are. What we do. Available from: http://www.scottishmedicines.org.uk/About_SMC/What_we_do/Remit
 NHS Choices website. Dupuytren’s contracture. Available from:
http://www.nhs.uk/Conditions/Dupuytrens-contracture/Pages/Introduction.aspx Last accessed 23.03.12
 Hart MG, Hooper G. Clinical associations of Dupuytren’s disease. Postgrad Med J 2005; 81: 425-428
 Trojian TH, Chu SM. Dupuytren’s disease: diagnosis and treatment. Am Fam Physician 2007; 76: 86-9
 Gudmundsson KG, et al. Epidemiology of Dupuytren’s disease: clinical, serological, and social assessment. The Reykjavik Study. J Clin Epidemiology 2000; 53: 291-6
 Bayat and McGrouther. Management of Dupuytren’s disease – clear advice for an elusive condition, Ann R Coll Surg Engl 2006; 88: 3–8
Last updated on: 21/05/2012