Personal experiences with Xiaflex and Needle Aponeurotomy

Xiaflex is now available, and is generating reports by both traditional writers and self published social media authors. There are now two minimally invasive treatments for contractures due to Dupuytren's disease - Xiaflex injection and needle aponeurotomy - with relative advantages and disadvantages of each. The following video was made by a Dupuytren's patient, documenting experience with needle aponeurotomy: http://www.youtube.com/watch?v=lGD9RjmFBzo. Another person's documentary experience with Xiaflex, also with videos, is posted here: http://bit.ly/9RhqQA. Their experiences were different, but both are satisfied with their results. Every hand is different and no one treatment works for everyone, but it's great that there are new options to choose from to buy time while researchers work for a cure. The Dupuytren Foundation is actively recruiting volunteers and fund raising options to develop better treatments - and eventually a cure. Support the effort. Make a difference. http://www.DupuytrenFoundation.org

Xiaflex Pricing

Auxilium has moved closer to product availability of Xiaflex collagenase injection for the treatment of Dupuytren's contracture by announcing the wholesale drug price: $3250.00 for a single treatment dose. For those who think that this seems high, consider this in perspective. There are many categories of pharmaceutical products. Most commonly available pharmaceuticals are classified as "small molecule" drugs: organic compounds "small" enough to be able to be absorbed directly into cells. Some small molecule drugs, such as morphine, penicillin, aspirin and cortisone have been used for years; others are new, like the cancer drug Gleevec. In contrast, "biologics" are complex large molecule organic compounds. Biologics are much more difficult (expensive) to purify than small molecule drugs. They are often produced using costly recombinant DNA technology. Biologics include Enbrel for rheumatoid arthritis, Botox for spasticity, and now Xiaflex for Dupuytren's contracture. Each of these biologics reduces the need for surgery for a specific condition. They are expensive, but cheaper than surgery. Who is going to pay for Xiaflex? The same sources that pay for surgery: private insurance, Medicare, or, if neither is available, the patient. The paperwork will be different, but the process will be quite similar. Auxilium has a patient information site http://dealingwithdd.com and physicians can call 1-877-663-0412 to get more information. Xiaflex cost should be compared not just to open surgery, which is widely available but more expensive, but also to needle aponeurotomy, which is less expensive than Xiaflex but available at fewer centers. Confusing? Somewhat, but it's great to have several options for treatment while we continue work to develop a true cure.

Needle Aponeurotomy and Xiaflex compared

Xiaflex (Collagenase) has finally been approved by the FDA for the treatment of Dupuytren's contracture. When work began on the development of collagenase to treat Dupuytren's contracture, the bar was pretty low: anything better than fasciectomy in terms of either safety or efficacy would be a great advance. No other treatment options were available in the United States. However, during the time that research was being performed on collagenase, needle aponeurotomy was introduced into the US and has gained some popularity. This changes the equation for collagenase - it's no longer the only alternative to fasciectomy. How will this play out? Read this comparison of needle aponeurotomy and Xiaflex (full text: http://handcenter.org/newfile20.htm) and decide for yourself.

FDA approves Collagenase for Dupuytren's

Collagenase (Xiaflex) has been approved by the FDA for treatment of Dupuytren's contracture, after years of intensive laboratory and clinical trials. Collagenase enzymatic  fasciotomy is more similar to needle fasciotomy than to either open fasciotomy or fasciectomy in terms of rapid recovery and low complication rate. Compared to needle release, collagenase enzymatic fasciotomy should eventually be more widely available (because it is easier for surgeons to learn), takes less time to perform, but provokes more inflammation and will be more expensive. Auxilium's press release (full text: http://www.dupuytrenfoundation.org/DupPDFs/2010_Auxilium1.pdf) and physician prescribing information (full text: http://www.dupuytrenfoundation.org/DupPDFs/2010_Auxilium2.pdf) are now available. We live in exciting times for Dupuytren's because for nearly 200 years, there has been essentially one treatment option, surgery, but within the last few years, this has expanded to also include needle release, dynamic fixation and now enzymatic fasciotomy. This has led to greater awareness of Dupuytren's. It is now time to transform this awareness into support for efforts to develop an actual cure.

A Sampling of Patient Information Brochures on Dupuytren's

What do health care providers think you should know or want to know about Dupuytren's? Here is a sampling of patient information materials from the government http://www.dupuytrenfoundation.org/DupPDFs/2010_NHS-ptinfo.pdf, http://www.dupuytrenfoundation.org/DupPDFs/2010_OBS-ptinfo.pdf, organizations of hand surgeons http://www.dupuytrenfoundation.org/DupPDFs/2010_AAHS-ptinfo.pdf, http://www.dupuytrenfoundation.org/DupPDFs/2010_ASSH-ptinfo.pdf, http://www.dupuytrenfoundation.org/DupPDFs/2010_BSSH-ptinfo.pdf, individual physicians and hospitals http://www.dupuytrenfoundation.org/DupPDFs/2010_eHand-ptinfo.pdf, http://www.dupuytrenfoundation.org/DupPDFs/2010_KWO-ptinfo.pdf, http://www.dupuytrenfoundation.org/DupPDFs/2002_Hurst-ptinfo.pdf, http://www.dupuytrenfoundation.org/DupPDFs/2010_Lancashire-ptinfo.pdf and hand therapists http://www.dupuytrenfoundation.org/DupPDFs/2010_Kramer-ptinfo.pdf. Of course, a wide range of information is also available on the Dupuytren Foundation web site: http://www.dupuytrenfoundation.org/What-is-Dupuytrens

Needle Aponeurotomy for Dupuytren's

Needle aponeurotomy for Dupuytren's contracture is a type of fasciotomy performed under local anesthesia. Compared to fasciectomy, it is less of an ordeal for the patient in terms of both procedure and recovery and has a lower complication rate. This report (full text: http://www.dupuytrenfoundation.org/DupPDFs/2008_Cheng_1610.pdf) reviews one group's experience with needle aponeurotomy.