Treatment for flexing finger disease could be a game-changer | Medical research

Researchers have hailed a breakthrough in the treatment of a common, incurable disease that causes hand deformities by firmly bending the fingers into the palm.

A clinical trial at the universities of Oxford and Edinburgh found that a drug used for rheumatoid arthritis appeared to reverse Dupuytren’s disease when used early, a result described as a potential ‘game changer’ for patients. patients.

“We are very keen to pursue this,” said Professor Jagdeep Nanchahal, a surgeon scientist who led the trial at the Kennedy Institute of Rheumatology in Oxford. “It is a very safe drug and it is important that patients can access treatment if it is likely to be effective.”

The disease is named after the French surgeon, Baron Dupuytren, who, in addition to claiming the honor of treating Napoleon’s hemorrhoids, acquired the arm of a dead man that he had “kept an eye on”, not wishing not to lose the opportunity to examine his permanently retracted fingers. Dupuytren’s disease affects around 5 million people in the UK, half of whom have progressive disease at an early stage.

Dupuytren’s disease is largely genetic and more common in people of northern European ancestry. Although some call it the “Viking disease”, there is no genetic evidence to support a link. It is often hereditary, but the exact cause is unclear, with factors such as alcohol and tobacco use, diabetes, age and sex all seeming to contribute. Men are eight times more likely to develop Dupuytren’s disease than women and in Western countries the prevalence rises from around 12% to 29% between the ages of 55 and 75.

“The problem for patients with bent fingers is that they interfere with everyday life: putting the hand in the pocket because it gets caught, putting on gloves, and it can be difficult to use a keyboard, and even driving,” Nanchahal said. Although more common in the past, some patients with severe and painful Dupuytren’s disease still require amputations.

The disease is a localized inflammatory disorder that develops when immune cells in the hand lead to the production of fibrous scar tissue. This creates lumps or nodules in the palm. Sometimes the disease stops there, but it can progress, forming strong cords under the skin that regularly contract and pull one or more fingers into the palm.

The lack of an effective treatment for the early stage of Dupuytren’s disease means that most patients must wait until their fingers are bent enough to qualify for surgery. Although the tissue can be cut, there is a risk of nerve and tendon damage, and the disease recurs in about a fifth of patients within five years. Another option is to use a needle to puncture and then break the cord, but the cords usually grow back.

Writing in Lancet Rheumatology, the Oxford group describes how injections of adalimumab, a drug used for rheumatoid arthritis and Crohn’s disease, into the nodules reduced their size and hardness compared to placebo injections. The volunteers received an injection every three months for a year. Follow-up examinations showed that the masses continued to shrink for nine months after the last injection. The drug, which costs the NHS £350 per injection, blocks signals from immune cells that instruct myofibroblasts to produce fibrotic tissue.

“We know the effect lasts up to nine months after the last injection, but assuming that at some point the nodule starts to grow again, then if approved the patient would return for four more injections,” Nanchahal said. Similar injections could help reduce cord recurrence after needle or surgical treatment.

Nanchahal is discussing the data with the Medicines and Healthcare Products Regulatory Agency to understand what evidence they need to approve the treatment. Ideally, patients would be followed for 10 years to see if adalimumab prevents hand deformities, but Nanchahal said that’s impractical. “We did our best with a patient population in a reasonable timeframe. We measured everything we can think of,” he said.

Professor Chris Buckley, director of clinical research at the Kennedy Institute, said the drug could be a game-changer and prevent the disease from progressing to the point where patients need surgery.

Sign up for First Edition, our free daily newsletter – every weekday morning at 7am BST

Professor Neal Millar, an orthopedic surgeon at the University of Glasgow, said the finding “could be hugely significant” over time. “It’s a big step forward in understanding the disease, but longer-term evaluation is needed if this is to be done as therapy,” he said.

Professor David Warwick, a hand surgeon specializing in Dupuytren’s disease at Southampton University Hospital, said: “While these are early results, this is an exciting and important project because it deals with cell biology.

“The needles are simple and usually work for a while, but the cord comes back. The surgery is usually successful, but it takes a while to recover and sometimes there are problems. But suppose we can treat Dupuytren’s disease before If she didn’t go that far in tackling cell biology, that would really change Dupuytren’s world.