Efficacy and safety of recombinant human epidermal growth factor for diabetic foot ulcers: A systematic review and meta‐analysis of randomised controlled trials

Abstract

To evaluate the efficacy and safety of recombinant human epidermal growth factor (rhEGF) in treating diabetic foot ulcers (DFUs), we conducted both database searches (PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science) and reference searches for randomised controlled trials from the inception of databases to 30 January 2020. Two reviewers independently scrutinised the trials, extracted data, and assessed the quality of trials. The primary outcome was the proportion of complete healing. The secondary outcomes were mean time to complete healing and adverse events. A subgroup analysis was performed by different administration routes. Statistical analyses were performed in RevMan 5.3. The time to complete healing Kaplan‐Meier curves was pooled in the R software. Of the 156 citations, 9 trials (720 participants) met eligibility criteria and were included. The rhEGF achieved a higher complete healing rate than placebo (OR: 2.79, [95% CI: 1.99, 3.99]). The rhEGF also significantly shorten complete healing time (MD: −14.10 days, [95% CI: −18.03, −10.16]). Subgroup analysis showed that topical application was superior to intralesional injection, but that may be because of different ulcer severity they included. No significant difference was shown in adverse events. Results were coherent with sensitivity analyses. Therefore, rhEGF is an effective and safe treatment for DFUs.

Efficacy of Human-Recombinant Epidermal Growth Factor Combined with Povidone-Iodine for Pressure Ulcers and Its Influence on Inflammatory Cytokines

“…EGF is shown to promote skin repair and remodeling by stimulating the growth of epithelial cells in wounds, thus speeding up wound healing [ 8 , 9 ]. In previous studies [ 10 – 12 ], rh-EGF was applied to the treatment of diabetic foot ulcer, burn wound, and cesarean section-caused wound scar, and a certain effectiveness, safety, and high wound healing rate were demonstrated, while PVI is an iodophor-based antibacterial agent with a variety of properties, including the ability to penetrate biofilm, anti-inflammatory effects, low cytotoxicity, and good tolerance, which is conducive to wound healing [ 13 ]. Evidence has indicated that PVI facilitates wound healing by promoting α -SMA and TGF- β secretion, neovascularization and re-epithelialization [ 14 ].…”

Comparative efficacy of growth factor therapy in healing diabetes‐related foot ulcers: A network meta‐analysis of randomized controlled trials

“… 13 Our results are more updated in comparison to the previous NMA, which included four trials investigating PRP in 113 participants, whereas the current NMA included 10 trials with 368 participants treated with PRP. 13 Improved wound closure using PRP 10 , 55 or EGF 56 compared to control has been reported in previous conventional meta‐analyses of RCTs as well.…”

Healing of diabetic foot ulcer with topical and oral administrations of herbal products: A systematic review and meta‐analysis of randomized controlled trials

“… 10 Additionally, ulcer healing following these treatments is reported to be poor and time‐consuming. 11 Hence, several adjuvant approaches have been recently investigated for the treatment of DFU, such as human amniotic membrane allograft, 12 recombinant human epidermal growth factor, 13 laser therapy, 14 platelet‐rich plasma, 15 hyperbaric oxygen therapy 16 and modern dressings. 17 However, the use of these adjuvant treatments is not without concerns, and the best strategies for the healing of DFU continue to be a challenge.…”