Becaplermin gel in the treatment of diabetic neuropathic foot ulcers

Abstract

Diabetic foot ulcers remain a major cause of morbidity. Signifi cant progress has been accomplished in ulcer healing by improved management of both ischemia and neuropathy in the diabetic foot. Nevertheless, there is a vital need for further improvement. Becaplermin gel represents an important therapeutic advance for diabetic neuropathic foot ulcers with adequate blood supply. Randomized controlled trials have shown that it is effective in increasing healing rates. However, this effi cacy has not translated to positive clinical experience, and the drug is not widely used. Moreover, becaplermin is an expensive medication. Even though it has repeatedly been estimated as cost-effective, its high cost may be prohibitive for some clinicians, especially in developing countries. Clearly, further work is needed to clarify whether use of becaplermin is justifi ed in everyday clinical practice. Future research also needs to assess the potential room for improvement with becaplermin, for instance by combination with other growth factors or by exploring alternative modes of drug delivery.

The Effects of Topical Application of Thyroid Hormone (Liothyronine, T3) on Skin Wounds in Diabetic Wistar Rats

“…Compared to other available modalities for treatment of diabetic wounds, topical T3 can easily prepared with low cost and more physiologic than several current therapies [10,11,13,18].…”

“…Diabetic ulcer, the leading cause of lower extremity amputations, is a common relapsing and often disabling complication of diabetes mellitus [7,8]. Most of current therapeutic options for diabetic ulcers are cumbersome and or expensive [9][10][11]. In this regard, a noticeable number of studies focused on topical therapy for diabetic ulcers [12][13][14].…”

Regenerative medicine: Current therapies and future directions

“…Incorporation of growth factors that promote healing or regeneration into biomaterials can provide a local and sustained presentation of these factors, and this approach has been exploited to promote wound healing by delivery of platelet derived growth factor (PDGF) (Regranex) and bone formation via delivery of bone morphogenic proteins 2 and 7 (Infuse, Stryker's OP-1) (16). However, complications can arise with these strategies (Infuse, Regranex black box warning) (17,18), likely due to the poor control over factor release kinetics with the currently used materials.…”

Safety and efficacy of Becaplermin gel in the treatment of diabetic foot ulcers

“…3 Traditional wound care efforts include offloading, sharp debridement of nonviable tissue, and restoring adequate perfusion. 4 In 2003, Sheehan et al changed the expectations of standard wound care. Their study included 203 diabetic foot ulcers, and of those that had at least 53% reduction in 4 weeks, 58% healed.…”

“…With this expectation, hyperbaric oxygen therapy, bioengineered skin substitutes, extracellular matrix proteins, and growth factors have been developed to expedite the slow healing process seen in diabetic foot ulcers. 4 …”