New jab fixes claw hand disease that hit Lady Thatcher
MILLIONS struck by a disease that leaves them with an almost useless ‘claw hand’ could soon benefit from a drug that halts the condition before it can do any damage.
It also means many could avoid risky surgery – which can damage sensitive nerves and tear tendons in the hand.
The drug, adalimumab, is a powerful anti-inflammatory already widely used to treat rheumatoid arthritis and given as an injection every three months.
British medics trialling its use for hand deformity say they were amazed at the drug’s effectiveness. Professor Jagdeep Nanchahal, an expert in hand surgery at Oxford University’s Kennedy Institute, where adalimumab is being tested, said: ‘My eyes popped out of my head when I saw the results. I thought, this is incredible.’
Claw hand, properly called Dupuytren’s disease, affects around five million Britons. It causes lumps of scar tissue to develop on the palms of the hands. Over time, these form thick bands, called cords, which pull the fingers of the hand inwards. Left untreated, the condition can make day-to-day tasks like writing, typing or preparing food extremely difficult.
The exact cause is a mystery but 80 per cent of cases are thought to be hereditary, and it usually affects those over 50. Famously, Conservative Prime Minister Baroness Thatcher suffered from it, as does actor Bill Nighy.
Non-surgical interventions – including steroid injection,
radiotherapy and shockwave therapy – have been trialled, but none have proved effective at halting the condition in its tracks.
As a result, the only real option is surgery, where the hand is cut open to strip away the diseased tissue.
In the UK, this is only offered in the advanced stages of the disease when the fingers are totally bent inward.
Now specialists hope adalimumab could halt the condition in the earlier stages.
It works by binding to and neutralising inflammatory molecules, called Tumour Necrosis Facto, or TNF – produced by cells in the palms of the hands. It’s thought inflammation is what triggers the
build-up of scar tissue that forms the cords.
On the Oxford trial, 140 patients with early-stage Dupuytren’s were split into two groups. One received a 40 mg injection of adalimumab – which costs around £350 per jab – every three months for a year, injected directly into the lumps on patients’ hands. The other group received a dummy drug.
Researchers found nodules shrunk significantly in the adalimumab group but not the placebo group. They also become much softer. Nine months after the treatment finished, the benefits were still evident in most patients, reducing the likelihood of surgery.
Professor Nanchahal said: ‘Adalimumab has been safely used to treat millions of people with arthritis around the world – we had no adverse events in our trial, so we know the drug is safe to use.’
Andrea Svalay, 60, from Highbury, north London took part in the adalimumab trial after suffering from Dupuytren’s disease for a year and a half. She first noticed a lump on the palm of her left hand in 2017. Soon, a cord began to form which she describes as a hard rope from the heel of her palm to the base of her finger.
Her GP referred her to a hand specialist who diagnosed Dupuytren’s disease. The bend in her finger was only five to ten degrees at the time– surgery is usually only offered once it reaches at least 30 degrees.
Andrea said: ‘I was told there was nothing I could do other than wait for surgery, and even then it might come back anyway. I know Dupuytren’s can make day-to-day activities like exercising or putting on make-up near impossible. I didn’t want to end up like that.’
Andrea was enrolled on the adalimumab trial in 2019 and had the injections into a lump on her left hand. She still does not know if she had the drug or the placebo but the lumps on her left hand have not progressed in the three years since and she has almost complete range of movement in it.
Meanwhile, the cord on her untreated right hand has grown progressively more prominent.
‘I’m very glad I got on the trial,’ she said. ‘If you can’t cure the condition, it’s fantastic to be able to prevent it from getting worse.
‘If I’m offered surgery on my right hand in future, I’ll take it, but I’d much rather have injections of adalimumab.’