Uso de Xiapex® en la enfermedad de Dupuytren

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La enfermedad de Dupuytren es un trastorno progresivo del tejido conjuntivo que afecta a la fascia palmar de la mano. Puede provocar contracturas en flexión de las articulaciones de los dedos, que conllevan un grado considerable de deterioro funcional e incapacidad. Xiapex® (colagenasa de Clostridium Histolyticum) se ha desarrollado como un tratamiento dirigido a la contractura de Dupuytren en pacientes con una cuerda palpable. Su actividad farmacológica consiste en la lisis selectiva de colágeno en el lugar de inyección, es decir, la cuerda de Dupuytren.

Consideraciones de administración

Se trata de un fármaco de acción local que no requiere exposición sistémica para ser eficaz. Cabe destacar que los tejidos de sostén de nervios, arterias y venas están compuestos principalmente de  colágeno tipo IV resistente a la acción de Xiapex®. El tratamiento con Xiapex® consiste en una inyección seguida de un procedimiento de extensión del dedo que se efectúa al día siguiente para romper la cuerda de Dupuytren. En la mayoría de casos se obtienen resultados satisfactorios tras la administración de una sola inyección, aunque también es posible que se necesite más de un ciclo de tratamiento.

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Ventajas del tratamiento con Xiapex®

La enfermedad de Dupuytren es de origen desconocido por lo que su tratamiento no es curativo. La cirugía es paliativa para mejorar la función de la mano, afectada por la contractura en flexión de los dedos afectados. Xiapex® se presenta como la única opción a la cirugía en esta patología, con una eficacia y seguridad demostrada con los datos que se conocen hasta el momento. Se aplicaría de forma ambulatoria en nuestra consulta externa, sin ningún tipo de hospitalización, y no requiere rehabilitación posterior ya que se ha demostrado suficiente la ferulización nocturna durante 3-4 meses y la realización de ejercicios activos por el paciente en su domicilio.

Indicaciones y contraindicaciones

El tratamiento con Xiapex® esta indicado si usted es adulto con enfermedad de Dupuytren con cuerda palpable que provoque contractura de uno o más dedos.

Las contraindicaciones para su uso incluyen: cirugía previa tendinosa en la mano afectada, tratamiento con tetraciclinas en los 14dias previos a al inyección, tratamiento con fluoroquinolonas concomitante, trastornos de la coagulación sanguínea, tratamiento con anticoagulante los 7 dias previos a la inyección, coexistencia de enfermedad autoinmune y embarazo. Usted debe poner en conocimiento de su médico si presenta alguna de las circunstancias anteriormente descritas.

Efectos secundarios después de la administración

Tras la administración de Xiapex® puede aparecer a nivel local inflamación de la mano, con equímosis (hematoma o morado), dolor leve, picor y adenopatías axilares transitoria (10%, con resolución espontánea en 1 mes). Tras el procedimiento de extensión puede aparecer como complicaciones la rotura de la piel, infección, lesión tendinosa, recidiva de la contractura, dolor regional complejo, etc. La eficacia y seguridad del fármaco se ha comprobado experimental y clínicamente, si bien al tratarse de un medicamento de reciente utilización podría presentar algún efecto de inmunización desconocido actualmente.

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