This article in the Drug and Therapeutics Bulletin (DTB) reviews the evidence for collagenase C. histolyticum (Xiapex) in the treatment of Dupuytren's contracture, a benign, progressive disabling condition of the hands, and discuss its place in the management of this condition.

Surgery has been the only effective treatment available until now, but is not a suitable option for all patients. Evidence from two trials indicated that Xiapex was more effective than placebo when assessed at 30 days after the last injection, but it is associated with many unwanted effects, particularly at the injection-site. Furthermore, there are no trial data comparing Xiapex with any active interventions, no long-term efficacy and safety data; and the cost-effectiveness of the drug is unclear. The authors of the review therefore concluded that such evidence is needed before Xiapex can be recommended as an alternative to current treatment options.