Is the drug Xiaflex worth getting excited about as a Dupuytrens treatment?

I’ve been reading that Xiaflex (used for Dupuytren’s contracture) was tested for Peyronie’s disease with pretty successful results and could be on the market as early as this year. Should I get my hopes up? Is this worth being excited about?



I am hearing more and more about nasty side effects and bad reactions from Xiaflex injections for Dupuytren contracture.  I think this is – or should be – the reason that Xiaflex has not been given fast approval as a Peyronie’s treatment.  I have spoken to people whose muscles and tendons have been injured (dissolved by the enzymes in Xiaflex) and the many problems they have to deal with as a result of these injuries. 

From the tone of your email I get the sense that you are genuinely hopeful about Xiaflex might do for you, because you feel so helpless against Peyronie’s disease.  Most men feel this way. You can get your hopes up, and you can get excited about it, if you wish.  Many people are sitting around waiting for a medical miracle cure while their lives slip away with a curved penis or useless hands.  They have the attitude that if there is no drug to save them, there is nothing to help them because the body cannot do anything against Peyronies disease or Dupuytren contracture.  Personally, I do not accept that line of thought.  I have seen too many people injured by drugs, like Xiaflex, and helped by Alternative Medicine. 

I believe a far more rational and safe approach to treating these two problems, and many others, is to first attempt more conservative treatment using a wide variety of simultaneous Alternative Medicine treatment methods.   Only after exhausting all possible conservative options would I remotely consider taking the calculated risk of a drug like Xiaflex.   The tone of your question suggests to me that you are not aware of, or even considering, the possible harm that can be done with a drug like Xiaflex.  

Many new drugs come on the market each year because of glowing reports and spectacular enthusiasm for the wonderful research results.  The new drug is highly advertised and heavily used for a while.  Then slowly and quietly new information comes out that bad things are happening to those who take this new wonder drug.  Even more quietly the drug is removed from the market a year or two later.  How many times have you heard that same story played out over and over?  High hopes based on questionable research, people hurt, drug withdrawal, many lawsuits. 

Why do we see so many TV commercials from lawyers who are trying to sue the pants off these drug companies?   The legal profession has created this large industry for itself because there are so many bad drugs on the market and so many people who are injured, that lawyers can profit from this misfortune.  What should that tell you?  The lawyers are not making this stuff up.  They are just taking great advantage of the huge opportunity they are given by bad drugs and injured people. 

Fact:  The U.S. is the heaviest user of drugs and surgery.  Fact: The U.S. is ranked about the 16th healthiest nation in the world, and we die at an earlier age, behind 15 other countries that take fewer drugs and use less surgery than we do.  If the use of drugs and surgery leads to health and long life, we should live the longest and be the healthiest country and we are not.  What does that tell you?

Sure, there are good drugs and not all drugs are bad.  But you must be extremely careful how you go about using them.  Xiaflex might help you, I cannot say one way or the other.  In my opinion, if you are going to use Xiaflex it should be the very last thing you do, not the first thing.  You should certainly talk to your doctor about your decision and educate yourself to the best level you can. How you approach the treatment of your problem is your decision.  TRH

Can I treat Dupuytren’s contracture naturally without surgery or drugs?

New Dupuytren non-surgical and non-drug treatment

Natural Dupuytren contracture treatment

Anyone who has spoken to his family medical doctor, orthopedist or hand specialist about Dupuytren contracture treatment has been told the only options are some form of hand surgery and Xiaflex drug injections.  But this is not true.

There is another viable Dupuytren treatment option and that is the use of Alternative Medicine to attempt to increase the healing ability of the body.  This is explained that with a better supported healing response the body will have a greater capacity to reduce or eliminate the Dupuytren lumps or cords, as well as reduce the finger contractures that eventually develop.

Avoid hand surgery and drug injections with Alternative Medicine

Dupuytren Contracture Institute has worked since 2002 with those who have had one or more hand operations, and has seen it is possible to eliminate or greatly reduce the need for a second surgery. Many of the people who work with our ideas find their doctors no longer want to do a second surgery after they make significant progress with natural therapies for their Dupuytren hand problem.

For those who never have had a Dupuytren operation, DCI suggests following a conservative treatment  option that consists of a short therapeutic trial of Alternative Medicine remedies first – rather than last – in an effort to possibly avoid hand surgery.  For those who already have had one or more Dupuytren surgeries, DCI suggests it is still possible to follow the conservative option but with reduced expectation.   Either way it makes sense to consider natural Dupuytren treatment as a way to possibly postpone or avoid another hand surgery.

Bulstrod, Loos and Messina are well respected medical researchers who report successful Dupuytren treatment outcomes with exercise, massage and traction, all without surgery. In spite of good clinical results their work is not given much interest because research funding is always directed toward innovative surgery and high profit drugs.   There is almost no financial incentive to research or document the value of the combined use of low cost natural Alternative Medicine treatment for Dupuytren contracture with, minerals, herbs, traction, massage or exercise that a person use at home.

Only a short therapeutic trial of aggressive natural treatment is needed to learn if your body can reduce or even eliminate the palm lumps of Dupuytren contracture.  To learn about the wide variety of natural self-management ideas that DCI has been developing since 2002, visit Different Way of Looking at Dupuytren Contracture Treatment.

Three primary reasons to avoid surgery for Dupuytren contracture

DCI has never suggested anyone not have hand surgery when it is recommended by a treating doctor.  But, DCI always recommends a patient learns the pros and cons of any therapy.  There are three fundamental things about Dupuytren surgery in all its forms or the use of Xiaflex injections that should be of special interest to anyone thinking about using them.

  1. Recurrence of Dupuytren contracture does occur after surgery.  No surgery or drug stops this problem, but delays it.  Eventual return of the nodules, lumps and cords, with gradual flexion contracture of the involved finger, develops again at the rate of 50% of people five years after surgery.  In later years that percent of recurrence continues to rise over time.  It is commonly held that eventually any9one who has had Dupuytren surgery will experience a return of the problem.
  2. Dupuytren surgery removes both normal and abnormal tissue from the hand and forever changes the physical relationship of tissue that remains, therefore after surgery the hand cannot return to a fully normal state and sometimes worsens.  Pain, stiffness, numbness, tissue hypersensitivity, reduced blood flow can all start – or worsen – after the kind of surgery that is done to remove Dupuytren lumps, nodules, cords and joint contracture.  Common and simple activities of daily living (washing, dressing, shopping, typing) can continue to a problem after surgery because normal tissue must be removed along with abnormal tissue of the hand.  Very often people who have had Dupuytren surgery learn they have simply traded one kind of hand problem for another; sometimes the new problem is less than the original one and sometimes it is worse. Anyone who thinks the hand will be like new after having a Dupuytren hand surgery will be disappointed.  The hand is always compromised in some new way that can be large and small, even though the immediate problem of finger contracture is usually improved for a few years after surgery.

In conversation with hundreds of people over the years who have had Dupuytren hand surgery, the two most frequent comments are:  1. “My finger is straighter, but now I have new hand problems.”   2. “I was definitely better for a year or two, and then the hand  problem came back worse than before.  I think I would not have had the first surgery if I knew it would only lead to a second one so soon, and so little genuine improvement.”

No Dupuytren surgery can make the hand as good as new, although everyone I have ever spoken to about their hand surgery has told me this is what they expected as the outcome of their hand surgery.

It is true that needle aponeurotomy (fasciotomy) is less invasive than different types of open hand surgery (fasciectomy), however NA still carries the problem of a much faster recurrence rate and presents the possibility of surgical error since it is done blindly because the surgeon is not able to see the tissue he is slashing with the needle tip.   For this reason, in this type of surgery the skill of the surgeon is extremely important.

  1. With each hand surgery that is done, the next hand surgery will be more complicated and subsequent risks greater because there is less normal tissue remaining in the hand and the increased development of scar tissue. The younger a person is when the first Dupuytren surgery is done, the more likely that person will need a second, then third, hand surgery.  If enough surgeries are performed it could happen that eventually no additional surgery can be done – no matter how painful or useless the hand becomes.  When this point is reached sometimes patients opt for finger amputation.

The Dupuytren Contracture Institute estimates that at least 80 percent of the people experience a moderate to marked degree of improvement of their hand problem within the first two to three months of Alternative Medicine treatment, when they faithfully follow our treatment suggestions for use of an aggressive therapy plan, using the therapy products found within this website.   Substituting bargain brand or questionable products while trying to treat this kind of deep soft tissue problem is not wise, and usually leads to disappointing results.


Xiaflex and Dupuytren Treatment

Xiaflex treats Dupuytren contracture by dissolving cords

Xiaflex is the brand name of the enzyme collagenase, produced by Auxilium Pharmaceuticals, Inc.,  that originates from clostridium histolyticum, the same bacterium that causes gas gangrene.  Actually, Xiaflex is a combination of two separate enzymes, called Aux-I and Aux-II that work together to break up the peptide bonds of the collagen protein. In early 2010 the FDA approved Xiaflex for treatment of Dupuytren contracture when a palpable cord is present; Xiaflex was not approved for Dupuytren treatment when only nodules or lumps on palms are found.

Dupuytren’s contracture is a slowly progressive condition that affects five times the number of men than women, affecting the deep soft tissue of the palm of the hand, called the palmar fascia.  The problem is characterized by excessive collagen deposition in the palmar fascia that leads to finger contracture caused by a nodule that can develop a rope-like cord. As Dupuytrens disease progresses, the cord can slowly cause the affected finger(s) to go into flexion contracture toward the palm of the hand.  With one or more fingers locked in a flexed contracture and unable to be straightened or extended, the individual with Dupuytren has significant problems with simple daily activities such as dressing, washing, toileting, and handling objects.

Xiaflex and Dupuytren treatment compared with surgery

The decision to use a surgical treatment for Dupuytren’s contracture depends on multiple factors:

1.    Stage and severity of the current condition
2.    History of prior hand surgery
3.    Status of the skin of the palm
4.    Age
5.    General health status
6.    Occupation
7.    Presence of complicating factors, such as the presence of bony deformity from joint disease or the like.

Surgery for Dupuytren’s contracture is typically considered a reasonable option only when the finger contracture causes a distortion of at least 30º of finger flexion.

Dupuytren surgical and drug options include:

1.   Fasciotomy – surgery in which only the offending cords are cut, without removal of any diseased fascia.  Needle aponeurotomy is a less invasive form of fasciotomy; it is a blind procedure in which the surgeon attempts to weaken the cords by tearing, puncturing and otherwise dividing the cords via a needle tip inserted through the skin, instead of a scalpel.

2.   Fasciectomy – surgery in which diseased, contracted and thickened tissue is cut and removed from the palm and fingers through incisions in the palm and affected finger(s).

a.    Partial fasciectomy – in which only mature and clearly deformed tissue is removed; it is often used in moderate to severe cases where 1 or 2 fingers are involved.

b.    Complete or radical fasciectomy – in which all bands of thickened and abnormal tissue that reduces joint movement and hand function are completely removed, sometimes requiring skin grafting if insufficient healthy skin is available due to the amount of tissue removed or when prior Dupuytren surgery has reduced the amount of available healthy tissue.

3.   Amputation of the affected finger(s) – surgery performed when hand pain and deformity is present to such a degree of impairment because past multiple Dupuytren surgeries have created so much scar tissue and removed so much tissue that no further surgery is possible.

4.  Xiaflex for Dupuytren treatment – used when cords, not nodules, are present.  Enables treatment to be done sooner when the MCP (metacarpophalangeal) or the PIP (proximal interphalangeal) joints are at 20º of finger flexion.   Thus, Xiaflex can be used 10º sooner into the finger flexion progression than surgery.

Xiaflex treatment of a Dupuytren cord requires a doctor to make multiple injections of Xiaflex into the palm of the hand into the Dupuytren’s cord at various points. Twenty four hours later the patient returns to the office for the doctor to forcefully break the cords that were enzymatically weakened the day before, by taking the fingers into extension

Xiaflex is injected into only one cord per treatment series, using a small quantity of Xiaflex solution that is divided between three injection sites selected by the treating doctor. If a first Xiaflex injection does not achieve the desired results then the procedure is repeated again one month later. A patient can only receive three series of Xiaflex treatments per Dupuytren cord.

In 70% of Xiaflex treatments the patient must return one month later for a second series of Xiaflex injections into the same finger cord to complete the procedure because of sufficient cord disruption did not occur at the first procedure.

Reasons to avoid Xiaflex as a Dupuytren treatment

Incorrectly performed injections of Xiaflex may cause damage of the local tendons, blood vessels, joints and nerves.   A mistake of injecting the Xiaflex by even 1mm can have terrible consequences in which permanent loss of finger movement or permanent injury to blood vessels and nerves can occur.    That is why the FDA requires that Xiaflex injections should be performed by a doctor who has been specially trained to make these collagenase injections.  However, this training consists of an online video that contains 20 minutes of training.

Each patient undergoing these injections must know that the recurrence rate of Dupuytren contracture after Xiaflex treatment is for 19.3% recurrence after two years.  This is a lower recurrence rate compared to fasciectomy (34% recurrence) and needle aponeurotomy (85%,recurrence), but still recurrence of the problem.  At this time no one knows if this recurrence rate increases with each subsequent series of injections, or if the degree of Dupuytren thickening worsens each time recurrence occurs..  Also, at this time, no one knows if the long term effects of repeated injections of Xiaflex on healthy tendons, ligaments, arteries, veins and blood vessels.

To avoid the possible side effects and adverse reactions of Xiaflex for Dupuytren treatment, it is worthwhile to consider first using more conservative Alternative Medicine methods before more radical methods like surgery or Xiaflex injections .

>>  Click here for FAQ about Dupuytrens.
>>  Click here for ideas how to treat Dupuytren contracture naturally.