Dupuytren’s disease (also called Dupuytren’s contracture or palmar fibromatosis) is a condition that affects the tissue under the skin...
Injectable Enzyme Medications
Evolution of Injectable Enzyme Medications
Injectable enzyme medications are a class of medicines that use tiny proteins (called enzymes) used by living organisms to break down other substances. Enzymes are used by many types of organisms, ranging from bacteria all the way to human beings. They each have a particular job, such as digesting food, metabolizing medications, and absorbing vitamins and nutrients. Scientists have long studied these proteins to understand bodily functions, and have deciphered the chemical structure of many particular enzyme proteins. Other scientists were then able to manufacture some of these same proteins in a lab and make them into an injectable form. This technology has allowed patients with enzyme deficiencies to regain missing functions. Recently, doctors and pharmacists started looking at using naturally-occurring enzymes for jobs other than their native function. The streptokinase enzyme has been harnessed and used to break down blood clots in important blood vessels, such as to treat stroke patients. Hyaluronidase is an enzyme that breaks down hyaluronic acid outside cells and can now be used to increase the absorption of other medications, including insulin.
Xiaflex® is an injectable form of the collagenase enzyme used by clostridium bacteria to digest collagen. When injected into a Dupuytren’s cord, the enzyme dissolves the collagen fibrils at the site of injection. This creates a weak spot in the cord, such that it either ruptures on its own, or is easily ruptured by the physician at a subsequent doctor visit. Collagen is also present in many other important structures of the hand, including the tendons that move our fingers, so it is important that trained professionals inject it directly into the cord, and not anywhere else. Success after an injection procedure has been defined as correction of the joint contracture to 5 degrees or less. While these rates vary according to how severe the contracture was beforehand, 50-75% of joints were treated successfully in the large CORD I and II trials. Recurrence of joint contractures seems to happen with any treatment, and has been observed in roughly half of Xiaflex patients within five years of treatment. Complications of Xiaflex injection most often include pain and swelling, as well as minor skin tears, and very rarely include more severe inflammatory reactions, and damage to the tendons or other structures in the hand.