The similarities between Collegenase and NA are so striking that Dr. Charles Eaton referred to the two as "competing" procedures. The only difference is in how an offending cord is broken. That's pretty much it. I don't think calling Collegenase "chemical NA" is an oversimplification. That's what it is. Here are the differences so far in my view, however:

1) NA takes more training, skill, expertise.
2) The cost of NA is labor driven while Collegenase's increased cost is in the injectable material.
3) NA is far more proven having been around for 35 years.
4) Collegenase *may* theoretically have lower recurrence rates.
5) American NA is typically performed at numerous points along a chord where Collegenase at fewer.

I have a guess as to why there is more trauma being reported with Collegenase. It sounds like the cord is more stretched than "snapped". When a cord cut by NA snaps the surgeon knows it. It breaks and releases. More backward pressure may be being applied to fingers with Collegenase because the MD doesn't have feedback as to his success. If the NA surgeon doesn't get results he simply works on the cord more. You don't have that immediacy with Collegenase.

I have just completed my series of injections and manipulations with Ausilium AA4500 and am very happy to announce that "IT WORKED". The only bad part was the fact that it took 3 injections drawn out over 90 days but it was worth it. Being that this was a trial, I also had to travel a considerable amount to the trial site. This made for some long days. As mentioned in earlier posts, the pain of the injection and tenderness during the first hours after injection were quite intense. I do believe that the pain and discomfort is infinitely less than that which would have been experienced as a result of surgery. Swelling and bruising were experienced after each injection. This subsided quickly and was completely gone within a week to 10 days. I went from 20+ degrees of deflection to <5. I can now put my palm flat and even raise my fingers off of the surface while doing it!

Hi moondanc,

thank you four your thorough assessment! I am sorry to hear that you Dupuytren's became so aggressive. I had a similar effect (though probably for orther reasons) after surgery and opted for radiotherapy which stabilized the condition and made the development much less aggressive.

I agree with you that collagenase won't eb a mmircale drug but we hope it will give us an additional option. We'll see. At least it is great that the trial is on-going and not on hold anymore.

Wolfgang

It seems to me there's one huge difference between NA and Collagenase that's not being discussed.

Collagenase (Xiaflex) costs $1,000 a pop and insurance companies are going to set guidelines on how many injections they'll pay for. The MD injects, waits a couple of days, and maybe tries a second injection. But if that doesn't work, he says "sorry" and you're done.

NA is a purposeful, manual technique. The MD knows what he's cutting and can 'feel' it to some extent. And, he sees the immedate result. He will keep cutting, withing safe bounds, until he succeeds and the cord is severed or can be snapped. Insurance isn't going to cut you off after 10 minutes regardless of outcom.

Maybe Collagenase can get into places where the cutting needle can't; but in the long run I believe NA will prove superior.

To size15n :

I'd been told earlier that Collegenase dissolves the cord but That's not consistent with some of the things I've read. I had a different, younger, study doc for my 90 day evaluation and I asked her directly and she said: "No, it does not dissolve, there's not enough of it, what it does is soften"

For other:
When looking at my left hand and my quickly advancing disease she advised me that with PIP contractures one shouldn't wait as long to get treatment as with MCP and then said--either surgery or NA. First time a "regular" OS has even allowed those words/initials out of his/her mouth!

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After the manipulation, I could. As explaned to me, the Collegenase disolves the chord rather than NA's perforation/break.