Contractures in the fingers caused by Dupuytren disease are commonly treated with either limited fasciectomy or injection of collagenase. Evidence to guide the choice of treatment is limited, but the DISC trial has now determined that collagenase injection is not noninferior to fasciectomy at 1-year post-treatment.

The pragmatic, open-label trial enrolled 672 people with a contracture of ≥30° in a metacarpophalangeal or proximal interphalangeal joint that was suitable for either treatment. At 1 year, the mean score on the Patient Evaluation Measure–Hand Health Profile (range 0–100, with higher scores indicating worse outcomes) was 11.9 in the fasciectomy group and 17.8 in the collagenase group; the estimated between-group difference of 5.9 points (95% CI 3.1–8.8) indicated that collagenase was not noninferior to fasciectomy at 1 year. Results of other patient-reported and joint-contracture outcomes at 1 year also seemed to favour the surgical intervention.