Comparative efficacy of growth factor therapy in healing diabetes‐related foot ulcers: A network meta‐analysis of randomized controlled trials
-
Published:2023-06-05
Issue:5
Volume:39
Page:
-
ISSN:1520-7552
-
Container-title:Diabetes/Metabolism Research and Reviews
-
language:en
-
Short-container-title:Diabetes Metabolism Res
Author:
Thanigaimani Shivshankar12ORCID,
Jin Harry1,
Ahmad Usama1,
Anbalagan Raghuveeran12ORCID,
Golledge Jonathan123ORCID
Affiliation:
1. Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia
2. The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia
3. The Department of Vascular and Endovascular Surgery Townsville University Hospital Townsville Queensland Australia
Abstract
AbstractIntroductionThis study examined the relative efficacy of growth factor therapies in healing diabetes‐related foot ulcers (DFU).MethodsPubMed and Cochrane databases were searched for randomized controlled trials testing growth factor therapies for treating DFU. The primary outcome was complete wound closure. Results were reported as relative risk (RR) ± 95% credible intervals (CrI). The risk of bias was assessed using Cochrane's RoB‐2 tool.ResultsA total of 31 RCTs involving 2174 participants were included. Only 13 of the trials (n = 924) reported on the aetiology of the ulcers (85.4% neuropathic and 14.6% ischaemic). Epidermal growth factor (RR 3.83; 95% CrI 1.81, 9.10), plasma‐rich protein (PRP) (RR 3.36; 95% CrI 1.66, 8.03) and platelet‐derived growth factor (PDGF) (RR 2.47; 95% CrI 1.23, 5.17) significantly improved the likelihood of complete ulcer healing compared to control. Sub‐analyses suggested that PRP (3 trials ‐ RR 9.69; 95% CrI 1.37, 103.37) and PDGF (6 trials ‐ RR 2.22; 95% CrI 1.12, 5.19) significantly improved the likelihood of wound closure amongst trial mainly recruiting participants with neuropathic ulcers. Eleven trials had a low risk of bias, 9 had some concerns and 11 had a high risk of bias. Sub‐analysis of trials with a low risk of bias suggested that none of the growth factors significantly improved ulcer healing compared with control.DiscussionThis network meta‐analysis found low‐quality evidence that Epidermal growth factor, PRP and PDGF therapy improved DFU healing likelihood compared with control. Larger well‐designed trials are needed.
Funder
National Health and Medical Research Council
Heart Foundation
Subject
Endocrinology,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
1. The Diabetic Foot;Evidence-based Therapy in Vascular Surgery;2023