Background: Dupuytren's disease (DD) is a progressive fibroproliferative disorder which is, in part, mediated by transforming growth factor beta 1 (TGF-β1). Angiotensin II receptor blockers (ARBs) have been shown to lead to upstream inhibition of TGF-β1 in several disease processes and proposed as a potential pharmacologic treatment in DD. The purpose of this study was to assess the association of ARBs with DD procedures and recurrence.
Methods: We queried the PearlDiver national insurance dataset to identify patients with a diagnosis of DD and at least 3 years of follow-up. A 1:1 matched cohort was made of patients who were not taking ARBs, and the primary outcome was the rate of index procedures for DD. A second 1:1 matched-control cohort was made among those with an index procedure, to assess for the rate of subsequent procedures as a correlate for revision procedures. We used multivariable logistic regression to assess specific factors associated with initial and subsequent procedures.
Results: The 3-year rate of index procedures was 21.9% in the ARB group and 17.6% in the control group (P < .001). The 3-year rate of subsequent procedures was 22.9% in the ARB group and 18.0% in the control group (P < .001). Angiotensin receptor blockers were independently associated with 1.32 higher odds of an index procedure (95% confidence interval [CI] 1.25-1.40) and 1.35 (95% CI 1.19-1.54) higher odds of a subsequent procedure.
Conclusions: Although we hypothesized that ARBs would be protective, our findings do not show an association with protection. Instead, the odds ratios suggest a higher risk of index and subsequent procedures.
Keywords: Angiotensin receptor blockers; Dupuytren’s disease; incidence; revision surgery; subsequent surgery.