Thanks to Juli for this information. NA refers to the needle aponevrotomy procedure performed by Dr. Badois in France and others.
The main reason I would do the NA treatment vs. the collagenase at this point in time is as follows:
1. Collagenase is still an experimental drug, now in phase III trials, and is not available to the public unless they are in the trial program. There is also a limit of 5 injections, and I have had 5 therefore having any more until the drug is approved is moot for me. It is only offered at Stonybrook and Stanford(?) in California.
2. Each collagenase injection in the clinical trial program requires about 12 follow-up visits. I was in the Stonybrook trial and live in Delaware, therefore each follow up visit was about a 12 hr day X12 visits X5 injections=60 trips @ 12 hr a trip. I was able to combine some trips but this is still a lot of travel time. This will be different once the treatment is approved and can be done by a local surgeon.
3. Each collagenase session treated only one cord vs. as many as 4 in one day and two the following day with NA. I am not sure how many collagenase injections can be done in one day, but it is probably restricted in order to maintain an upper concentration limit of enzyme in a localized region of the hand. This is a big factor for me as to why I preferred the NA treatment. I was able to have 6 cords treated in a two day period. I don't think collagenase can be administered to treat this many cords in this short a time period.
4. NA will probably always be less expensive than collagenase as collagenase is a patented treatment, requires expensive processing equipment to make, will be regulated by the FDA, and will be administered by a hand surgeon. NA in Europe costs between $50-$100 per session. Collagenase will likely be no less than $1000, probably much more than that per treatment, if I had to guess.
5. As of this date (May 29, 2003) collagenase is probably 2-4 years from FDA approval and then surgeons will need to be trained and enzmye manufactured adding more time before it is routinely available.
6. Collagenase is administered in a specific dosage. If it doesn't sufficiently depolymerize (disolve) the cord, you need another treatment. In my case the first two injections worked like a charm. I had recurrence within two years and then two out of the next three injections afterwards did not work as well as the first two. Although in one case it was on a very thick cord and the other on the PIP joint which, as I understand tends to be problematic.
In the NA procedure the physican can continue to cut the cord until it is severed. Don't get me wrong, I think the collagenase treatment is a much better alternative to surgery. I think realistically it is many years away and it is false hope to think otherwise. I held out for at least I year hoping the collagenase would be approved, and finally gave up and went the NA route. Collagenase saved me from having surgery and I didn't have recurence for 2 years. Since my NA was just done last week, I have no idea how long it will be before I need another treatment.
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