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NA vs. AA4500
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11/15/06 01:38
JF

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11/15/06 01:38
JF

not registered

NA vs. AA4500

Assuming that AA4500 achieves satisfactory results in the Phase III trials (obviously a non-trivial assumption) and gets through FDA, what would be the relative merits of treatment via AA4500 over NA at that point?

(I know this has been discussed in part on other topics, but it wasn't quite clear to me...thanks.)

11/15/06 01:47
Randy H.

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11/15/06 01:47
Randy H.

not registered

My 2 Cents

Collagenase may prove to be able to weaken Dups tissue that might be hard to get to with NA. Our NA guys have done some *amazing* things, but I believe Denkler indicated that Collagenase might extend his grasp, especially where the PIP is involved.

MCP joint is a "snap" for NA (so to speak) so Collagenase would simply be a far more expense way to do the same thing on that joint.

Some CHS have suggested that Collagenase may not be as prone to recurrence as NA, but we have no data on that speculation.

I also would speculate that eventually Collagenase could be used to disrupt nodules in the palm through direct injection. This has not been tried, but why wouldn't it work? We'd all like these sometimes painful little suckers zapped wouldn't we?

If a cord is too diffuse, NA can't cut enough of it to weaken it. In fact, Eaton told me that with enough repeated NA this can eventually happen. It may be that multiple injections of Collagenase would do the trick here where NA can't.

We don't know what Collagenase treatment might cost, but it will certainly be more than NA. So, in practical and economic terns, NA should be the workhorse, and Collagenase the backup for difficult cases. I doubt it will work that way, depending on how far the NA movent gets before Collagenase is available. Many CHS may just take the FDA approved method (and easy way out) with Collagenase and not learn NA. Let the insurance companies pay for it. I'm not wild about that eventuality, and that's why we should support the increased use of NA so it will have a strong foothold before the competition arrives. NA and Collagenase are competitive procedures, make no mistake.

11/16/06 01:06
diane 
11/16/06 01:06
diane 
Randy~sq~s 2 cents

Randy
thanks for your post with thoughts on comparison between NA and collagenase. I have been wondering how useful this drug will be as compared to NA and will it help in the situations where NA is only partially effective due to rapid recurrance or tissue that is difficult to reach. When I last saw Dr. Denkler for a follow up cortisone shot on previous NA, he was all excited about the availability of collagenase in two or three years and seemed to think my treatment plan was to keep my finger together until collgenase is available. I still wonder how it would be better than just getting NA every year or two which is a doable thing.

thanks again, if anyone learns anything on this topic, please post. thanks

11/16/06 01:05
Mark D

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11/16/06 01:05
Mark D

not registered

Repetitive N.A.

Diane:

I think I read somewhere that there tends to me a maximum number of times that N.A. can be repeated.

Perhaps Randy, Wolfgang, or one of our other leaders, could enlighten us about that.

Mark

11/17/06 01:56
Wolfgang

not registered

11/17/06 01:56
Wolfgang

not registered

repeating NA

NA does little damage and I wouldn't expect a hard limit of how often it can be repeated. I guess it will depend on the individual, how cords and skin develop, and how much which joint is bent. Probably there will be a limit eventually though we likely don't have enough statistics on that. But experts like Drs. Eaton or Denkler could certainly answer that question better.

Charles Eaton writes on his NA-FAQ page

"NA may not be technically possible when the skin has lost its stretchiness - if
- The skin itself has shrunk or hardened too much.
- There are tight lengthwise scars from previous surgery.
- There are skin grafts in the middle of the contracted area.
- The skin over the cord is hard, scarred, or nodular (lumpy)."

Will collagenase be any better? So far I don't think anybody really knows. It might be easier to apply but you still have the same limitations, e.g. the skin needs to be elastic and it won't help when your PIP already got fixed in its bent position. Besides that nobody really knows whether collagenase stays within the cord or whether it might spread into the joint removing healthy collagen (sort of worst case outcome: your finger is straight again but unfortunatly you can't bend it anymore ...). NA is simple mechanics, that might even turn out an advantage. But untrained doctors will love collagenase because probably it won't require trainig.

Wolfgang

11/17/06 01:42
Randy H.

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11/17/06 01:42
Randy H.

not registered

Limitations

Mark, Wolfgang,

Eaton informed me that some people with numerous NA re-treatment eventually wind up with a wider more diffuse cord that NA can't touch. He has not seen this, but the French have as they've been doing NA for 30+ years. Eaton wasn't specific, but it sounded like it would take may years and a lot of NA before this eventuality.

Would Collagenase suffer from the same limitation? One would think. They are just two ways to do the *exact* same thing. One is less expensive and has a proven track record. Still, the more the merrier when it comes to the offering of noninvasive treatment for *any* orthopedic procedure: knees, hips, you name it. Now it's *our* turn.

Bottom Line:

My question to Eaton then became, "What % of new Dups patitnets could use NA to avold OS entirely?" ANSWER: "Something *well* over 50%".

11/17/06 01:40
Mark D.

not registered

11/17/06 01:40
Mark D.

not registered

Multiple N.A..s

Wolfgang & Randy:

Thanks for the info.

Mark

11/19/06 01:41
BG

not registered

11/19/06 01:41
BG

not registered

NA+ AA4500

combination of NA+ AA4500- this is the true

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technically   Collagenase   treatment   limitations   noninvasive   availability   satisfactory   competitive   repeated   speculation   certainly   re-treatment   combination   unfortunatly   non-trivial   stretchiness   eventually   Wolfgang   competition   eventuality