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The U.S. Food and Drug Administration (FDA) has approved Xiaflex, a new drug to treat Dupuytren's contracture (or disease) that was discovered and developed by Lawrence C. Hurst, M.D., and Marie A. Badalamente, Ph.D., in the Department of Orthopaedics at Stony Brook University Medical Center. Dupuytren's contracture is a debilitating hand disorder caused by progressive accumulation of collagen that deforms fingers and limits motion and affects millions worldwide. The new treatment is the first FDA-approved non-surgical treatment for Dupuytren's contracture. Previous FDA-approved clinical trials of the drug, an injectable form of the enzyme, collagenase, showed that it significantly improves outcomes in patients with the disease.

Dupuytren's contracture Before
Dupuytren's contracture Before
Dupuytren's contracture After
Dupuytren's contracture After

The February 2, 2010, FDA approval comes after months of review of Xiaflex, which will be manufactured by Auxilium Pharmaceuticals, Inc., based in Malvern, PA. Shortly after Drs. Hurst and Badalamente published their study results on the use of the collagenase treatment for Dupuytren's contracture in The New England Journal of Medicine on September 3, 2009, an FDA advisory panel had voted unanimously (12-0) to recommend the drug as a treatment to combat the hand disorder. Auxilium is moving forward to launch marketing and production of Xiaflex, which is expected to be available to orthopedic surgeons and hand specialists in March.

"The FDA decision is a monumental one in that patients with Dupuytren's contracture will now have an alternative treatment that does not require surgery and has been shown in clinical trials to be very effective," says Dr. Hurst, Co-Principal Investigator and Professor and Chair of the SBUMC Department of Orthopaedics, who indicates that hundreds of patients with the hand disorder have already contacted him about the treatment in recent weeks.

"The FDA approval is the culmination of many years of research, development and clinical trials for a treatment that is now poised to become a new standard of care for many patients with Dupuyren's contracture,” says Dr. Badalamente, Professor in the SBUMC Department of Orthopaedics.

Drs. Hurst and Badalamente began their research more than 15 years ago in their laboratory when they first realized the enzyme had potential to treat Dupuytren's disease. The investigative process has resulted in a bench-to-bedside story that began with successful laboratory results on breaking up collagen within fibroproliferative tissue of the cords that cause the finger contractures. Their laboratory experiments eventually led to FDA-approved clinical trials. The FDA decision is a crowning moment in their bench-to-bedside story.

The SBUMC-led study of the use of the drug in treating 308 patients with Dupuytren's disease at 16 sites nationwide reported in the September 3, 2009, issue of The New England Journal of Medicine, indicated that the injections are safe and effective. Other participating institutions enrolling patients in the trial included Stanford Hospitals and Clinics in Palo Alto, Calif., University of California, Los Angeles, the Hospital for Special Surgery in New York, and the Indiana Hand Center in Indianapolis.

"Our study revealed that injections of the collagenase into the cords causing the finger contractures weaken the cords significantly," says Dr. Hurst. "The next day we found that we could manipulate the patient's fingers and break the cords causing the contracture. The result is frequently a complete correction of the joint contracture."

Dr. Hurst says that most patients with advanced Dupuytren's disease would be candidates for treatment with injectable collagenase regardless of age. He also contends that because the majority of patients with the condition are older and often have other significant comorbidities (i.e. diabetes), they are more likely to experience neurovascular injury, hematoma, and infection following surgery. Recurrence after surgery also remains problematic.

Dupuytren's disease is a progressive genetic fibroproliferative disorder in which normal collagen production and deposition in the hand fascia is disrupted and abnormal amounts of collagen production build nodules in the palm of the hand. Eventually collagen build-up produces cords in the hands of patients causing the fingers to be "bent" and unable to extend. This reduces finger dexterity to a high degree, to a point where common activities such as typing, cooking and even shaking hands become difficult and severely compromised.

Millions worldwide are affected by Dupuytren's contracture, with the highest incidence (3-to-6 percent) being in the Caucasian population of Northern European ancestry. The condition is more common in men than women and increases in incidence with advancing age, diabetes, epilepsy, smoking, and excess use of alcohol.

The Department of Orthopaedics at Stony Brook University Medical Center will soon open the "Dupuytren's Institute" to further support patient care, research, and educational aspects of this debilitating disease which so often interferes with the quality of life, particularly in later years. To help educate physicians, surgeons and therapists about Dupuytren's disease, Dr. Hurst and Dr. Badalamente will be co-hosting a Dupuytren's Disease Continuing Medical Education (CME) Symposium at Stony Brook University on April 17, 2010.

The Department of Orthopaedics at Stony Brook University Medical Center provides full-service patient care and sub-specialty resident and fellowship training in all areas of orthopaedics and hand surgery. The department includes a comprehensive Orthopaedic Research Program featuring clinical and laboratory facilities and resources for investigation of molecular, biologic, and biomechanical research topics.

Stony Brook University, a member of the prestigious Association of American Universities and one of only 94 institutions in the country to be designated a "Very High Research University" by the Carnegie Foundation, finished FY 2009 with $173M in sponsored program expenditures. Stony Brook's tripartite mission of education, research, and public service is supported by extramural funding from both public and private sponsors, predominantly the National Institutes of Health, National Science Foundation, Department of Energy, and NY State.

Stony Brook has the most active and successful technology licensing program in the SUNY system and is consistently ranked within the top 25 programs nationally according to the Association of University Technology Managers, with Stony Brook faculty responsible for more than 1,400 inventions and 400 active patents. SBU accounts for over 95% of the aggregate licensing revenues system-wide. Stony Brook co-manages Brookhaven National Laboratory, joining an elite group of universities–including Berkeley, University of Chicago, Cornell, MIT, and Princeton that run federal research and development laboratories. The Offices of the Vice President for Research include http://www.stonybrook.edu/research/oed/the Offices of Sponsored Programs, Grants Management, Multidisciplinary Research, Research Compliance, Economic Development and Technology Licensing and Industry Relations. For more information about Stony Brook's research enterprise, see http://www.stonybrook.edu/research/.
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