Chris:

Thanks for your clarification.

Your restatement seems closer to what the guys-in-the-know on this site have been saying.

But, it still seems to me that we're dealing with a gray area.

Mark

The ex-president of the ASSH was scheduled to head a Phase III trial of Collegenase Injections (CI) at UCLA, and he still may if the money finally arives through Auxilium. I was on his waiting list to be a participant in 2003 when BioS could not fund the project. Darn! Not being aware of NA I had OS instead when my PIP reached 45 degrees. It was the opinion of this particular CHS that Collegenase was still so untested that having OS may have been the better choice, which is to say he is still skeptical. We need completion of Phase III to prove this stuff is safe and effective. As we know, so far CI has caused *no* collateral damage whatsoever and has a success rate equivalent to NA.

I'm conflicted. As a staunch NA advocate I have written extensively on it's defense on the BioS forum and here. If I, and others like me, were to achieve our goal of NA's vindication and acceptance into common use, that could reduce the chance of CI ever seeing the light of day. That would be an unfortunate outcome as I believe CI may have the potential to be more effective in some cases than NA. I guess just like Auxilium I must rely on the intransigence of most CHS who simply will *not* cut what they can't see. This regardless of Eaton/Denkler's stellar work and accomplishments showing NA is far safer than OS :-) Go Figure.

In reponse to Jim's comments,

Yes my surgeon did say that nurve damage is a possibility on the second and latter sugeries. This was mainly because scar tissue can become interweaven with the nurve after the first surgery. He also said that of the thousands of patients he has operated on for this condition only 5 have nurve damage. He has never given any patient nerve damage on the first surgery.

It does seem that from these results Jim is one of the rare and unlucky cases.

Surgery is proven to have the lowest recurence rate of all the techniques and is said (in the opinion of my surgeon) to be the best option for patients who are younger (<55 years old) and have more aggressive forms of the disease. N.A is a good option, if you have access to it, are in the older age group and therefore not as concerned with recurrence and someone in the younger age group. Older people also tend to have less aggressive contractures and therefore will require less time between treatments of N.A.

The current treatment that has the lowest recurrence rate (<10%) is skin the graft procedure. This applies only to patients that have quite pronounced dupuytrens contracture. Radiation treatment might (although don't quote me on this) have lower recurrence rate for patients who have caught the disease in the early stage and have less aggressive Dupuytrens.

Getting back to Auxilium's statements - the stated price of $5,000 is just more hype aimed at investors. Every venture startup claims their product has a huge potential market and will command a premium price. If and when the product is ever produced, the market determines a price at that time. Or I should say, the insurance companies will decide what they're willing to pay.

For now, I would not be holding my breath waiting for AA4500. The endlessly on-and-off trials were stopped early this year - and right on schedule, another analyst jumps in and "initiates coverage", essentially calling the stoppage a golden opportunity for investors:

http://www.newratings.com/analyst_news/article_1539751.html

So the trials are back on hold while Auxilium works the "investor conference" circuit and another round of new money is pulled in. Maybe the trials will be restarted later this year, or maybe not.

Hello,
I don't want this to get into an argument, because all I am doing is reciting more or less word for word what I was told by my surgeon. Yes he is a hand surgeon who only does open surgery, but it was his opinion that a primary treatment of standard open surgery, followed by a skin graft, if the first surgery is not successful is the best course of treatment. He was well aware of the other types of surgeries and I discuss them in depth with him.

I would also suggest that the purpose of this forum is to give people advise and not exageration. It is not (for the vast majority of patients) months of painful rehabilation, especially for young patients who heal more quickly. A hand surgeon would say the rehabilitation for patients under 55 years old would be moderatly painful for the first week and after that gradually subside which I would say from experience is about right. For older patients it might take a bit longer, but certianly not months of painful rehabilitation.

I also never said patients should not get N.A before open surgery. All I said was that this was not the advise given to me by my surgeon. You are free to get N.A if you would like it, but statistically you are more likely to have the disease come back again. For me, as a 28 year older who has already had one surgery, I can see that no amount of N.A is going to help me - there are just too many nodules and lumps. I need to have tissue physically removed from my hand.

I would also say that of all the Dupuytrens surgeries my surgeon has performed (he reckoned thousands), he has only ever amputated once and that was for a patient who was requesting amputation rather than out of absolute nessecity.

As I have already said in the past if your contractures are minor then N.A might be a good option.

I think another thing to remember about this forum is that what you have experienced with either N.A of O.S is not nessecarily the norm. We should not push our opinion of one surgery over another based on our individual experience. Opinions should be given by surgeons, and based of statisical evidence. Our experience of what happened to us, in our individual cases, should only be used to give others an idea of what can happen - not what will happen!