your guide to xiapex

The aim of this booklet is to provide a guide for patients who are thinking about choosing XIAPEX® as a treatment. The information in this booklet is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please discuss any concerns with your GP or Specialist. Your Specialist will also be able to advise further on the suitability of surgery dependent on how severe your symptoms are.

This guide will help you by:

• Explaining how XIAPEX® would be administere.
• Answering some common questions relating to this condition and XIAPEX®.

XIAPEX® is a non-surgical treatment for Dupuytren’s contracture for adults with a stiffening of the rope-like cord that pulls the fingers towards the wrist. This is known as a palpable cord contracture.

XIAPEX® consists of enzymes called collagenases, which break down this cord allowing the fingers to extend as near to straight as possible again.

Dupuytren’s disease is a condition which affects the tissue in the palm of the hand and the fingers. Dupuytren’s disease can cause one or more fingers to become permanently bent inward. When this occurs, it is called Dupuytren’s contracture. Dupuytren’s contracture starts with a build up of cells in the palm of the hand which leads to small lumps. These lumps are benign (non-cancerous) and usually painless.

Dupuytren’s disease is fairly common. More men than women have the condition, which tends to occur later in life. It is estimated that it affects up to 20% of men over 60 years of age, and 20% of women over 80. The condition can run in families although the exact cause if not fully understood.

In some cases of Dupuytren’s contracture the symptoms are mild and no treatment is necessary. However, treatment may be required if the normal function of your hand is affected beyond a measurable point.

Treatment begins with two visits to your Specialist, one to receive the injection and another where your Specialist will manipulate your finger to help extend the cord. If you have Dupuytren’s contracture in multiple fingers, your Specialist will advise you on which finger should be treated first, as only one cord should be treated at a time.

Visit 1: The Initial Assessment and Injection procedure

Your Specialist should be able to provide you with treatment at your first appointment where appropriate. As this is not a surgical procedure no incision will be required. Instead, your Specialist will use a fine needle to inject directly into the affected area. After your injection, your hand will be wrapped in a gauze dressing. You will be asked to remain at your treatment centre for up to 30 minutes to make sure you do not have an allergic reaction to the medicine. If you experience discomfort please tell the clinic staff.

Your doctor or nurse will provide you with important instructions to follow when you return home. These may include: 

• You will not be able to drive yourself home.
• Do not perform strenuous activities with your affected hand.
• Avoid bending or straightening the fingers of your affected hand.
• Keep your hand elevated (above your elbow) as much as possible.
• Do not try to break the cord that received the injection on your own.
• Avoid getting the gauze dressing wet.

You should contact your doctor or nurse immediately if you experience any of the following:

• Signs of an allergic reaction, such as wide spread redness or rash, swelling, tightness in the throat or difficulty breathing.
• Dizziness or fainting.
• Swelling, numbness or tingling in the treated hand.
• Signs of infection, such as fever or chills.

You will be asked to return the following day so your Specialist can make sure the injection was successful and perform the finger straightening procedure. In some cases, a treated finger may straighten on its own following the injection. It is very important that you do not try to force your finger to straighten. Most people experience swelling, bruising and bleeding around the injected area. Please see the leaflet that comes in the XIAPEX® package for a full list of potential side effects.

Visit 2: Next Day Finger Straightening or Manipulation Procedure

When you return for your second visit, your Specialist will remove the gauze dressing and straighten your finger to manipulate the cord. This procedure may cause some discomfort and your Specialist may give you a local anaesthetic.

You may experience some swelling or bruising of the treated hand following this procedure. This is normal. It is also possible that your skin may tear during the straightening procedure, especially if your skin is attached to the cord. Your Specialist will tell you how to look after your skin if this does happen. Your doctor will also recommend the appropriate medicines if you need pain relief.

Before leaving, you will be given a splint to wear on your finger at bedtime. You will also be given some finger exercises to do daily. Your healthcare professional will be able to advise you when it will be safe to begin using your hand fully again.

Visit 3: 30 day Post Manipulation Follow-up

You will be asked to return to your doctor for a follow-up visit around 30 days later. After discussing it with your doctor and only if necessary, you may need to receive further treatment. You may also be asked to continue wearing your splint at bedtime for a further few months. If treatment does not reduce symptoms significantly after the first treatment, you can have up to two more, each should be separated by 30 days.

XIAPEX® should only be used to treat one cord at a time. If you have more than one joint or other fingers affected with a cord, they will be treated separately and your Specialist will advise accordingly.

Currently there is no permanent cure for Dupuytren’s disease. However, XIAPEX® is an effective treatment option for Dupuytren’s contracture in adults with a palpable cord and is generally well tolerated. However, because it does not treat the disease that causes the contracture it is possible that contracture may reoccur. In this case, your doctor may recommend another course of treatment with XIAPEX or one of several other treatment options.

• It is only for adults with a palpable cord.
• You may want to be accompanied by a friend, family member or caregiver to your appointments.You will be unable to use your hand following the procedures, and you will be unable to drive yourself home.
• You should make sure your doctor knows of any other medicines you are currently taking, including non-prescription medicines.
• It is not suitable if you are taking medicine that is used to thin your blood (anticoagulants) including warfarin and clopidogrel. However, low dose aspirin may be suitable (up to 150 mg per day).
• It is not recommended if you have taken tetracycline antibiotics (such as doxycycline) 14 days before your injection.
• It is not recommended if you are pregnant or breast feeding.

You should contact your doctor or nurse immediately if you experience any side effects after treatment that concern you. Most side effects experienced by patients were mild and generally went away within 2 weeks of the procedure.

Very common (affecting more than 1 user in 10) side effects were:

• Reactions at the injection site like bleeding, pain, swelling, tenderness and bruising.
• Itching on the hand.
• Pain in the hand, wrist or arm.
• Swollen or enlarged glands near the elbow or under the arm.
• Swelling in the hand or arm.

Common (affecting 1 to 10 users in 100) side effects were:

• Reactions at the injection site like pain, warmth, swelling, blistering, redness and/or rash.
• Skin wound at the site of injection.
• Pain in the glands near the elbows or under the arm.
• Joint swelling and pain.
• A burning sensation, partial loss of sensitivity, feeling of ‘pins and needles’ and/or numbness.
• Dizziness, headache, nausea.
• Increased perspiration.

You may want to discuss any concerns you may have about side effects with your doctor, nurse, or other healthcare professional.

Q. Can any doctor perform the procedure?

A. Only doctors who are trained in the XIAPEX® injection and extension procedures can perform the treatment. This may mean you will need to see a new doctor for your treatment, or travel to a different clinic or hospital than the one you normally use.

Q. Will I need to have physiotherapy after XIAPEX®?

A. You will be expected to do the daily finger exercises recommended by your doctor. Your doctor will let you know of any additional physiotherapy you may need.

Q. What if both of my hands are affected?

A. You will have XIAPEX treatment performed on one cord at a time. You can receive treatment on another cord or the other hand in the future.

Q. How soon after treatment can I return to work?

A. Your doctor will be able to advise you on when you can resume normal or strenuous activity following treatment.

Q. Where can I find more information about Dupuytren’s disease?

A. At the NHS Choices website.