Researchers have hailed the breakthrough in treating a common, incurable disease that causes deformities of the hand.
A clinical trial at Oxford University found that a drug used for rheumatoid arthritis reversed Dupuytren’s disease with early use, resulting in it being described as a potential “game changer” for patients.
Professor Jagdip Nanchahal, a surgeon at the Kennedy Institute of Rheumatology in Oxford, who is leading the trial, said: “We want to continue this.” “It’s a very safe drug and it’s important that patients can get treatment if it can be effective.”
Named after French surgeon Baron Dupuytren, who had the privilege of treating Napoleon’s hemorrhoids, he took the hand of a “watchful” man who did not want to miss the opportunity to examine his permanently dislocated fingers. Dupuytren affects about 5 million people in the UK, half of whom are in the early stages of the disease.
Dupuytren is most common in people of genetic and northern European descent. Although some call it “Viking disease,” there is no genetic evidence to support the link. It often occurs in the family, but the exact cause is unclear with factors such as alcohol and tobacco use, diabetes, age and gender. Males are 8 times more likely than females, and in Western countries the prevalence increases from 12% to 29% between the ages of 55 and 75 years.
“The problem for patients with bent fingers is that they interfere with daily life: putting your hand in your pocket because it can be difficult to hold, wear gloves, use a keyboard, and even drive,” Nanchahal said. Although previously common, some patients with severe and painful Dupuytren’s disease still require amputation.
The disease is a localized inflammatory disease caused by the production of fibrous scar tissue by the immune cells of the hand. This creates knots or knots in the palm. Sometimes the pain stops there, but it can develop under the skin, forming strong cords that pull one or more fingers to the palm.
The lack of effective treatment in the early stages of Dupuytren requires most patients to wait until their fingers are sufficiently bent for surgery. The tissue can be cut, but there is a risk of nerve and tendon damage, and the disease will return in about five percent of patients within five years. Another option is to pierce the needle and then tear the cord, but the threads will usually grow back.
The Oxford group writes in the journal Lancet Rheumatology that it describes how injecting adalimumab, used for rheumatoid arthritis and Crohn’s disease, reduced their size and hardness compared to placebo injections. Volunteers received injections once every three months for a year. Subsequent examinations showed that the tumors had shrunk for nine months after the last injection. Once in the NHS, the drug, which costs £ 350, blocks the signals of immune cells that tell myofibroblasts to destroy fibrous tissue.
“We know that the effect lasts for up to nine months after the last injection, but if we assume that at some point the nodule will start growing again, then if this is agreed, the patient will return for four more injections,” Nanchahal said. Similar injections can help reduce the recurrence of needles after a needle or surgical treatment.
Nanchahal is discussing the data with the Agency for Regulation of Medicines and Health Products to understand what evidence is needed to approve treatment. Ideally, patients would be monitored for 10 years to find out whether adalimumab to prevent hand disability, but Nanchahal said this is not the case. “We did our best in a patient population within a reasonable time. We have measured everything we thought, ”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 developing to the point where patients need surgery.
Professor Neil Millar, an orthopedic surgeon at the University of Glasgow, said the discovery “could be of great significance” over time. “It’s a big step in understanding the disease, but if it works as a therapy, a long-term assessment is needed,” he said.
Professor David Warwick, a hand surgeon at Southampton University Hospital who specializes in Dupuytren, said: “While these are preliminary results, it is an interesting and important project because it looks at cell biology.
“Needles are simple and effective for a while, but the cord comes back. Surgery is usually successful, but it takes some time to recover and sometimes there are problems. But can we treat Dupuytren before we turn to cell biology? Now it would really change Dupuytren’s world. ”