RESUMO
Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased (P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.
Assuntos
Contratura de Dupuytren/terapia , Procedimentos Ortopédicos/tendências , Fatores Etários , Fasciotomia/métodos , Fasciotomia/tendências , Humanos , Injeções Intralesionais , Colagenase Microbiana/administração & dosagem , Colagenase Microbiana/uso terapêutico , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Procedimentos Ortopédicos/métodos , Estados UnidosRESUMO
BACKGROUND: While limited data from clinical trials show differences in efficacy between topical acne combination products and monotherapies, the impact in clinical practice is not explored. PURPOSE: To evaluate the effectiveness in clinical practice of prescribing topical acne combination treatments compared to monotherapy product(s) in minimizing treatment failures. METHODS: Patients diagnosed with acne (ICD-9: 706.1) by a dermatologist between January 2009 and September 2011 and initially prescribed a topical acne treatment were identified. Multivariate Cox proportional hazards models were employed to compare the hazards of treatment failure for patients initially prescribed a combination product versus one monotherapy or multiple monotherapies. Subgroup analyses were also performed. RESULTS: Three hundred and thirty-five patients were initially prescribed topical product(s) exclusively. The hazards of treatment failure for those prescribed a combination product compared to those prescribed one monotherapy product was HR = 0.91 (p = 0.65) and compared to those prescribed multiple monotherapy products was HR = 0.73 (p = 0.17). LIMITATIONS: Disease severity and treatments prescribed outside of the hospital system were not available. CONCLUSIONS: Treatment failures were consistent for patients prescribed combination product(s) or monotherapies.