Efficacy of intralesional recombinant human epidermal growth factor in chronic diabetic foot ulcers

Dumantepe, Mert; Fazlioğulları, Osman; Seren, Mustafa; Uyar, İbrahim; Basar, Fahrettin

doi:10.3109/08977194.2015.1031898

Cited by 27 publications

(24 citation statements)

References 20 publications

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“…Topical use of growth factors was observed to reduce the incidence of lower limb amputation. Studies suggest good tolerability profile with frequent adverse events that include burning sensation, tremor, chills and local pain [47]. This is also confirmed by a prospective, active post-marketing surveillance study in 41 hospitals and 19 primary care polyclinics wherein 1835 DFU patients on rhEGF were evaluated [48].…”

Section: Figurementioning

confidence: 66%

Growth factors for diabetic foot ulcers: mixed treatment comparison analysis of randomized clinical trials

Sridharan

Sivaramakrishnan

2018

Brit J Clinical Pharma

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Keywords autologous platelet transfusion, epidermal growth factor, platelet derived growth factor AIMS Topical growth factors accelerate wound healing in patients with diabetic foot ulcers (DFU). Due to the absence of head-to-head comparisons, we carried out Bayesian network meta-analysis to compare the efficacy and safety of growth factors. METHODSUsing an appropriate search strategy, randomized controlled trials on topical growth factors compared with standard of care in patients with DFU, were included. Proportion of patients with complete healing was the primary outcome. Odds ratio (95% confidence interval) was used as the effect estimate and random effects model was used for both direct and indirect comparisons. Markov Chain Monte Carlo simulation was used to obtain pooled estimates. Rankogram was generated based on surface under the cumulative ranking curve (SUCRA). RESULTSA total of 26 studies with 2088 participants and 1018 events were included. The pooled estimates for recombinant epidermal growth factor (rhEGF), autologous platelet rich plasma (PRP), recombinant human platelet-derived growth factor (rhPDGF) were 5.72 [3.34, 10.37], 2.65 [1.60, 4.54] and 1.97 [1.54, 2.55] respectively. SUCRA for rhEGF was 0.95. Sensitivity analyses did not reveal significant changes from the pooled estimates and rankogram. No differences were observed in the overall risk of adverse events between the growth factors. However, the growth factors were observed to lower the risk of lower limb amputation compared to standard of care. CONCLUSIONTo conclude, rhEGF, rhPDGF and autologous PRP significantly improved the healing rate when used as adjuvants to standard of care, of which rhEGF may perform better than other growth factors. The strength of most of the outcomes assessed was low and the findings may not be applicable for DFU with infection or osteomyelitis. The findings of this study needs to be considered with caution as the results might change with findings from head-to-head studies.British Journal of Clinical Pharmacology Br J Clin Pharmacol (2018) 84 434-444 434

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Section: Figurementioning

confidence: 66%

Growth factors for diabetic foot ulcers: mixed treatment comparison analysis of randomized clinical trials

Sridharan

Sivaramakrishnan

2018

Brit J Clinical Pharma

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“…A prospective study published in 2014 evaluated 33 venous ulcers treated with EGF embedded in a collagen-based dressing and found a significant beneficial EGF result (41) . Two clinical trials evaluated the successful regenerative potential of EGF in diabetic ulcers (42)(43) . Therefore, the use of EGF seems to be an interesting and promising alternative for the treatment of chronic ulcers, such as venous etiology.…”

Section: Comparison Between Treatment With Growth Factors or Standardmentioning

confidence: 99%

Treatment of venous ulcers with growth factors: systematic review and meta-analysis

2019

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Objective: To identify evidence about the effects of growth factor application on venous ulcer healing. Method: Systematic review and meta-analysis, including Randomized Clinical Trials. Searches: Ovid MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, LILACS, Web of Science, Digital Library of Theses and Dissertations; Google Scholar and list of references. Results: 802 participants were recruited from the 10 included studies: 472 in the intervention group (growth factors) and 330 as control. The relative risk for the complete healing outcome was 1.06 [95% CI 0.92-1.22], p = 0.41. Participants who received Platelet-Rich Plasma and Epidermal Growth Factor showed a slight tendency to achieve complete healing, but without statistical relevance (p <0.05). Most of the studies were classified as moderate risk of bias. Conclusion: The effect of the application of growth factors for complete healing in venous ulcers is not clear, and clinical trials with methodological quality are required for more accurate recommendations.

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“…Intralesional administration of experimental agents is one of the most promising directions in studies of DFU. Many topical drugs are important in the treatment of DFUs, such as EGF, basic fibroblast growth factor (bFGF), granulocyte macrophage colony‐stimulating factor (GM‐CSF), platelet‐derived growth factor (PDGF), which can accelerate the healing of DFUs. An autologos platelet‐rich plasma gel was also found to be an effective local dressing in the treatment of diabetic ulcers .…”

Section: Discussionmentioning

confidence: 99%

Topical 1% propranolol cream promotes cutaneous wound healing in spontaneously diabetic mice

Zheng

Liu

Yang

et al. 2017

Wound Repair Regeneration

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Vascular endothelial growth factor (VEGF) expression was significantly lower in the experimental vs. control group whereas NG2 proteoglycan was increased throughout the study. However, matrix metallopeptidase (MMP)-9 expression was at first significantly higher in the experimental vs. control group then the MMP-9 protein level in the control group increased and surpassed that in the experimental group. In conclusion, intralesional administration of 1% propranolol cream promotes reepithelialization and regulates abnormal angiogenesis in diabetic wounds. Propranolol cream may become a new drug for the treatment of DFUs.

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Efficacy of intralesional recombinant human epidermal growth factor in chronic diabetic foot ulcers

Abstract: Intralesional EGF administration up to complete closure can be safe, effective and suitable to improve healing of chronic diabetic foot ulcer (DFU).

Cited by 27 publications

References 20 publications

Growth factors for diabetic foot ulcers: mixed treatment comparison analysis of randomized clinical trials

Growth factors for diabetic foot ulcers: mixed treatment comparison analysis of randomized clinical trials

Treatment of venous ulcers with growth factors: systematic review and meta-analysis

Topical 1% propranolol cream promotes cutaneous wound healing in spontaneously diabetic mice

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