Improving Diabetic Wound Healing Outcomes with Topical Growth Factor Therapies: Systematic Review and Network Meta-analysis of Randomised-controlled Trials
Andrew Yew Wei Wong, Natalie Ming Foong Hooi, Brian Sheng Yep Yeo, Rehena Sultana, Yong Mong Bee, Ainsley Ryan Yan Bin Lee, Sook Muay Tay- Biochemistry (medical)
- Clinical Biochemistry
- Endocrinology
- Biochemistry
- Endocrinology, Diabetes and Metabolism
Abstract
Context
Diabetes mellitus is associated with morbid complications such as diabetic foot ulcers (DFUs) that may lead to amputations or mortality if not managed adequately.
Objective
New adjunctive interventions to treat diabetic wounds include topical biologics and growth factors. This study aims to evaluate their efficacy in improving wound healing outcomes and safety.
Data sources
Comprehensive database searches of MEDLINE via PubMed, EMBASE and Cochrane performed from inception to December 2022.
Study selection
Three independent researchers selected the studies. Randomised-controlled trials that compared the use of a topical biologic growth factor-containing regimen to other biologics or standard of care (SOC) were included.
Data extraction and synthesis
This review followed PRISMA guidelines. Risk of bias analysis was performed using the Jadad scale. Network meta-analysis was performed. Treatments were grouped into common nodes based on the type of biologic agent.
Main outcomes and measures
Primary outcomes of interest were healing rate and time to wound closure. Secondary outcomes included wound infection, serious adverse events, and amputation rate.
Results
Human umbilical cord (HUC) was associated with the highest cure, followed by recombinant human epidermal growth factor (hEGF). A significantly greater reduction in the time to cure DFUs was seen in HUC, hEGF and fibroblast growth factor (FGF). There was a significantly lower risk of adverse events (AEs) when platelet-rich plasma (PRP) was administered.
Conclusion
HUC, hEGF and FGF are promising topical biologics with statistically significant primary outcomes compared to SOC, while PRP is effective in reducing ulcer-related AEs. HUC has been found to be the most effective in terms of cure rate and a reduction in time to cure.