Marys Medicine

Hands2elbowsurgeon.co.uk

A non-surgical treatment for Dupuytren's contracture1*
Your guide to
The information in this guide is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please refer to the Xiapex Package Information for full safety and product information.
*Xiapex is for adults with a rope-like cord that can be felt beneath the skin of the palm (also known as a palpable cord)1 This medicinal product is subject to additional monitoring.

You have been diagnosed with Dupuytren's contracture
and fol owing discussions with your doctor about treat-
ment options you may be considering Xiapex, a medical
procedure that could help to treat your condition.2
The aim of this guide is to:
• Explain how Xiapex works
• Describe how Xiapex would be administered to you
The first symptom of Dupuytren's contracture is usually growth of small lumps of tissue on the palm of the hand. Other symptoms are unusual dimples, thickening of the skin or tenderness around the palm.3 Over time, bands of contracted tissue can develop in the hand, making it difficult for you to straighten your fingers in the same way as before. This process may take months or years.3 The ring finger is most commonly affected by Dupuytren's contracture, followed by the little finger and then the middle finger. One or both hands can be affected.3 As Dupuytren's contracture progresses, the fingers may eventually be pulled into a permanently bent position. This can make it difficult, for example, to wash your face, put on gloves, play the guitar, shake someone's hand, type on a computer keyboard or handle tools.3

What is Xiapex?
Xiapex is the first medicine approved for
adults with Dupuytren's contracture who have
a palpable cord.1,2
The treatment begins with two visits to your doctor, one to receive the injection and another when your doctor will extend your finger.1 Xiapex works by using enzymes called collagenases, which break down the cord.2 Xiapex is injected directly into the cord so that when correctly administered, the risk of complication in other collagen-containing tissues is minimised.2,4 Your doctor or nurse will provide you with
What is involved in Xiapex
important instructions to fol ow when you return
home. These may include:
• Do not perform strenuous activities with your affected hand1
Only doctors who are trained in the Xiapex injection and • Avoid flexing or extending the fingers of your affected hand1 extension procedures can perform the treatment.1 • Keep your hand elevated as much as possible1 • Do not try to disrupt the cord that received the injection on The following
After 30 days
• Avoid getting the gauze dressing wet Finger-straightening
Follow-up visit
Contact your doctor or nurse immediately if you
experience any of the fol owing:
• Signs of an al ergic reaction, such as skin itching, hives,
difficulty breathing or tightness in your chest1 Visit 1: The Xiapex injection procedure
• Dizziness or fainting1 • You will go to your doctor's surgery or an outpatient • Swel ing, numbness or tingling in the treated hand1 department at your hospital for this injection. No cuts into • Signs of infection, such as fever or chil s1 the skin of your hand will be needed.1 Instead, your doctor wil use a fine needle to inject Xiapex directly into the cord.1 After your injection, your hand will be wrapped in a gauze dressing.1 • You will be asked to remain in your doctor's surgery for 30 minutes to make sure you do not have an al ergic reaction to the medicine. If you experience discomfort, please tell your doctor.
You will be asked to return the following day for the finger-straightening procedure.1

Visit 2: The finger-straightening
procedure
• When you return for your second visit the day after, the gauze
dressing will be removed. Your doctor will be able to extend your finger as the cord is dissolved by the Xiapex treatment.1 This procedure may cause some discomfort, so your doctor may give you a local anaesthetic.1 • You may experience some swel ing or bruising of the treated hand fol owing this procedure.1 • Before leaving, your doctor or nurse will provide you with a splint to wear on your finger at bedtime. You will also be given some finger exercises to perform each day. Your doctor or nurse will be able to advise you when it will be safe to begin using your hand ful y again.
In some cases you will be asked to return to your doctor for a follow-up visit 30 days later.1 If your doctor feels it is necessary, you may receive another full treatment of Xiapex.1 You will also be asked to continue wearing your splint at bedtime for up to four months.1 If your cord is not dissolved after the first treatment, you can have up to two more treatments, with a four-week interval between each treatment.1 What are the side effects of
• Pain in the glands near the elbows or under the arm1 • Joint swel ing and pain1 • A burning sensation, partial loss of sensitivity, feeling of ‘pins and needles' and/or numbness1 In clinical trials, most side effects experienced by patients • Dizziness, headache, nausea1 treated with Xiapex were mild to moderate and generally disappeared within two weeks of the procedure.1 • Increased perspiration1 The side effects are listed from very common to uncommon.
Uncommon side effects experienced by 1-10 out
of 1,000 users:
Side effects experienced by more than 1 in 10
• Rupture of a tendon, ligament injury1 • Allergic reaction1 • Reactions at the injection site, such as bleeding, pain, swel ing, • Chronic pain1 tenderness and bruising1 • Muscle spasm, weakness and muscle and bone stiffness or • Itching on the hand1 • Pain in the hand, wrist or arm1 You may want to discuss any concerns you may have about side • Swol en or enlarged glands near the elbow or under the arm1 effects with your doctor or nurse.
• Swel ing in the hand or arm1 You must inform your doctor if you are breastfeeding or are Side effects experienced by 1-10 out of 100
pregnant, or if you have been taking anticoagulants (medicines, such as warfarin and aspirin that thin the blood) or antibiotics, as Xiapex treatment may not be appropriate for you.1 • Reactions at the injection site, such as pain, warmth, swel ing, blistering, redness and/or rash1 • Skin wound at the injection site1

Wil my condition return?
Xiapex is a general y tolerable and effective treatment option for
Dupuytren's contracture in adults with a palpable cord.1,2 Currently
there is no complete cure for Dupuytren's disease. The symptoms
can be treated, but regardless of which treatment you receive,
Xiapex or any other non-surgical or surgical treatment, the
contracture may reappear in the future.1,5 In that case, your doctor
may recommend another course of treatment with Xiapex.1
Important information you
• Xiapex is only for adults with a palpable cord1
• You may want to be accompanied by a friend, family
member or caregiver when you go for your appointments.
You will be unable to use your hand fol owing the
procedures, and you will be unable to drive1
• You should make sure your doctor knows of any other
medicines you are currently taking, including non-
prescription medicines and vitamins1
• Xiapex is not suitable if you are taking medicine to thin
your blood (anticoagulants), including warfarin and aspirin1
• Xiapex is not recommended if you have taken tetracycline
antibiotics (such as doxycycline) 14 days before your
injection1
• Xiapex treatment is not recommended if you are pregnant1

Frequently asked questions
Will it hurt?
Some transient pain will occur. You may experience some
swelling or bruising of the treated hand following this
procedure.1 Your doctor will tell you how to look after your skin
if this happens. Your doctor will also recommend the appropriate
medication if you need pain relief.
When can I start using my hand normal y again?
When your finger has been straightened, your doctor will
encourage you to resume normal activities but to avoid strain for
a certain period.
Will I need physiotherapy after Xiapex?
You will be expected to do the daily finger exercises
recommended by your doctor. Your doctor will let you know if
you require any additional physiotherapy.
How does this affect my ability to drive a car or
other vehicle?
Swelling and pain can impair the function of the treated
hand.1 You should therefore avoid driving, riding a motorbike
or operating machinery until you get the go-ahead from your
doctor.

Frequently asked questions
How soon after treatment can I return to work?
Your doctor will be able to advise you on when you can resume
normal or strenuous activity following treatment.
Will the treatment be affected if I take other
drugs?
In some cases, yes. If you are taking, or have recently taken, any
other medicines, such as antibiotics to treat the infection, blood-
thinning agents or non-prescription medications, you should
consult your doctor.1
I have problems with blood clotting/thinning.
Can I be treated with Xiapex?
It depends. Consult your doctor.
I am pregnant. Can I be treated with Xiapex?
There are no studies on pregnant women. Treatment should
therefore be postponed until after pregnancy.1 Treatment with
Xiapex can be implemented during lactation.1
When is Xiapex not recommended?
If you are you allergic to the active substance in Xiapex
(collagenase clostridium histolyticum bacteria) or any of the
other substances, do not undergo treatment with Xiapex.1

Important details about your
Date of Xiapex injection: Location and time of appointment: Surgeon/consultant name: Contact for questions/concerns: Date and time for finger extension procedure: Date and time of follow-up visit: Other important information: In the space below, please list any questions you may have for your nurse or surgeon and bring this with you on the day of your injection.
1. Xiapex Summary of Product Characteristics. Nov 2013.
-2014 MARS 2014 LINDH & P 2. Hurst LC et al. N Engl J Med 2009; 361(10):968-79.
3. NHS Choices website. Dupuytren's contracture. Available at: www.nhs.uk/ Conditions/Dupuytrens-contracture. Accessed December 2013.
4. Thomas A et al. Ther Clin Risk Manag 2010; 6:557-72.
5. Bulstrode NW et al. J Hand Surg Am 2005; 30(5):1021-5.
SE-112 76 Stockholm Sweden

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