Sunday 1 July 2012

An interview with a Dupuytren's / Xiapex specialist - Dr Elliot Sorene

So today I have some questions that I sent to Dr Elliot Sorene. Elliot Sorene MB BS FRCS (Tr & Orth) EDHS is a leading specialist on the use of Xiapex for the treatment of Dupuytren's in the UK. He is currently at the University College Hospital, London where among other things he has been selected to lead a team of consultants for hand and wrist injuries for the London 2012 Olympics. Here I have asked him about the use of Xiapex for the treatment Dupuytren's and his thoughts on this treatment.

You can find more information out about him on his website London Hand. (Information above and picture used with permission from the above link) For more information on Xiapex it is something I covered a bit here.

I have to say that I really appreciate that a professional who works on these diseases is willing to take the time to answer my questions. In fact due to this yes and one from Dr Richard Shaffer I have sent out a few more e-mails to see if I can get anyone else to agree to share some information with us. 

1) How long having you been treating Dupuytren's disease and roughly how many Dupuytren's patients have you treated? 

I have been treating Dupuytren’s disease for 15 years and I have treated hundreds of patients.

2) How common do you think Dupuytren's is in the UK? 

Dupuytren’s disease is very common in the United Kingdom.

3) What percentage of the patients you have treated have had a family history of Dupuytren's or a related disease? 

Many of the patients do have a positive family history or related condition.

4) I have seen that you treat with Xiapex, what is Xiapex and how does it work?  

Xiapex is an enzyme called collagenase that dissolves part of the Dupuytren’s cord. (The cord is mainly formed of collagen and collagenases break down collagen)

5) At what stage of Dupuytren's is Xiapex administered? 

Xiapex is administered when there is a symptomatic Dupuytren’s cord causing a contracture

6) Why is Xiapex a better course of action than surgery or radiotherapy? 

Radiotherapy can be used for nodules and disease before there is a contracture. (With a view to delay disease progression).

The results with Xiapex are similar to surgery however there are fewer issues with wound healing, dressings changes, scarring and physiotherapy. Often with Xiapex the recovery is in terms of days or weeks as compared to months after surgery.

7) Xiapex is used to treat Dupuytren's and I have seen that it is in trails for a related disease, Peyronie's. I suffer from Ledderhose disease and I have seen no information linking Xiapex to Ledderhose disease, why is this?

7b) I was recently contacted by a patient suffering from Dupuytren's and Ledderhose whom has had radiotherapy for Ledderhose and Xiapex for Dupuytren's. Overall they were very happy with the Xiapex but also found that it helped the painful nodules in their hands and therefore does not see why at least some tests or trials are not being done using Xiapex on Ledderhose disease, what do you think about this?

Ledderhose is managed normally by foot surgeons and this is not my field however I see no reason why Xiapex could not be used for a symptomatic contracture in the foot.

Xiapex like surgery does have a recurrence rate. Just as surgery is not often indicated for nodules nor is Xiapex . Often nodules in the hand are painful in the proliferative phase of the first year or two and then may hurt less. Surgery on a nodule in the proliferative phase may cause recurrence and a cord or contracture formation.

8) Finally do you have any advice or other information that you would like to share with Dupuytren's / Ledderhose patients and what's your website address? 

My advice would be to view this condition as being very common in certain population groups and in effect a normal finding.

Treatment is only indicated in the presence of a symptomatic cord causing a contracture. Treatment (apart from with radiotherapy) in the presence of nodules should only be undertaken bearing in mind that the treatment itself could hasten progression to symptomatic cords or contractures.

I would like to say thank you again for the willingness shown to answer these questions and I hope that it proves useful to Dupuytren's patients out there. 

1 comment:

  1. Use of an enzyme such as collagenase is logical as it can reduce fibrosis and the nodules of plantar fibromatosis are largely a form of scar tissue. Nevertheless, hyaluronidase has been available in the US for several decades with a similar effect. I have been treating plantar fibromatosis with injections of hyaluronidase mixed with a small amount of triamcinolone acetonide and a local anesthetic successfully for over 15 years. That technique has been enhanced in recent years by the availability of a more concentrated form of hyaluronidase called Vitrase, manufactured by Ista Pharamaceuticals and by performing the injections under sonographic guidance.
    Ed Davis, DPM, FACFAS
    San Antonio, TX, USA