Treatment for finger-bending disease may be ‘gamechanger’

A breakthrough in the treatment of a disease that causes hand deformities by bending the fingers firmly into the palm has been hailed by researchers.

A trial at Oxford University found that a drug used for rhythym appeared to drive Dupuytren's disease into reverse when used early on.

Prof Jagdeep Nanchahal, a surgeon scientist who led the trial at Oxford's Kennedy Institute of Rheumatology, said that they are very keen to pursue this.

The disease is named after Baron Dupuytren, a French surgeon who claimed to have treated Napoleon's haemorrhoids, but kept an eye on a dead man. Half of the 5 million people in the UK are affected by Dupuytren.

People with northern European ancestry are more likely to have Dupuytren. There is no evidence of a link between the two diseases. Alcohol and tobacco use, diabetes, age and sex are some of the factors that can cause it in families. Men are eight times more likely to develop Dupuytren than women, and the prevalence increases between the ages of 55 and 75.

It can be hard to use a keyboard and even drive if you have bent fingers. Some patients with Dupuytren still request amputations, even though it is more common in the past.

When immune cells in the hand drive the production of fibrotic scar tissue, the disease develops. This causes a lump in the palm. Sometimes the disease stops there, but it can progress to form strong cords under the skin that pull one or more fingers into the palm.

Most patients are told to wait until their fingers are sufficiently bent to qualify for surgery because of the lack of effective treatment for early stage Dupuytren. There is a risk of nerve and tendon damage if the tissue is cut out, and the disease can return within five years. The cords typically grow back if you use a needle to perforate and snap them.

The Oxford group describes how injections of adalimumab, a drug used for rheumatoid arthritis and Crohn's disease, into nodules reduced their size and hardness compared with placebo injections. The volunteers received an injection every three months. Nine months after the final injection, the lumps continued to shrink. The drug blocks signals from immune cells which tell myofibroblasts to make fibrotic tissue.

The effect lasts for up to nine months after the last injection, but if this were approved, the patient would come back for another four injections. Similar injections could help to reduce the regrowth of cords.

The Medicines and healthcare products regulatory agency is talking with the data to understand what evidence they need to approve the treatment. Patients would be followed for 10 years to see if adalimumab prevents hand deformities. He said that they had measured everything they could think of.

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

The finding could be hugely significant in time, according to Prof Neal Millar, an orthopaedic surgeon at the University of Glasgow.

Although these are early results, this is an exciting and important project because it addresses cell biology.

Needles are usually effective for a while, but the cord can come back. It takes a while to recover from surgery and sometimes there are problems. We can treat Dupuytren before it ever gets that far by addressing the cell biology. That would change the world of Dupuytren.