Becaplermin gel in the treatment of diabetic neuropathic foot ulcers

Figures & data

Table 1 Overview of the phases of normal wound healing (Kirsner and Bogensberger 2002; Jeffcoate et al 2004; Falanga 2005)

Phase	Main cell types	Main activity
Coagulation	Platelets	Vasoconstriction, clot formation, secretion of growth factors, and cytokines
Inflammation	Leukocytes (neutrophils, monocytes, macrophages)	Chemotaxis of inflammatory cells, eradication of bacteria, and necrotic debris
Migration/proliferation*	Keratinocytes, fibroblasts, endothelial cells	New vessel formation, fibroplasia
Remodeling	Fibroblasts	Wound contraction, realignment of collagen fibers to increase tensile strength, scarring

* Notes: Otherwise known as maturation.

Table 2 Clinical trials of PDGF in diabetic foot ulcers. Copyright © 2007 SAGE Publications. Reproduced with permission from Papanas N, Maltezos E. 2007. Growth factors in the treatment of diabetic foot ulcers: new technologies, any promises? Int J Low Extrem Wounds, 6:37–53

Platelet-derived growth factor
Author	Year	Study design	Comparison	Main findings
Steed	1995	Double blind placebo controlled	Topical PDGF gel 30 μg/g vs. placebo	Complete ulcer closure at 20 weeks: 48% vs. 25%, p = 0.01
Wieman	1998	Double blind placebo controlled	Topical PDGF gel 100 μg/g vs. 30 vs. μg/g vs. placebo	Complete ulcer closure: 49.5% vs. 36% vs. 35%, p = 0.007 Mean time to heal: 86 days (100 μg/g) vs. 127 days (placebo)
D’Hemercourt	1998	Randomized double-blind placebo-controlled	Topical PDGF gel 100 μg/g vs. carboxymethylcellulose gel vs. good ulcer care	Complete ulcer closure: 44.1% vs. 35.7% vs. 22%
Embil	2000	Phase IIIB open-label	Safety of topical PDGF gel 100 μg/g	Complete ulcer closure: 57.5% Mean time to heal: 63 days
Smiell	1999	Meta-analysis*	Topical PDGF gel 100 μg/g vs. placebo	Complete ulcer closure: 50% vs. 36%, p = 0.0007 Mean time to heal: 14.1 weeks vs. 20.1 weeks, p = 0.01

* Notes: Meta-analysis of the studies by Steed (1995), Wieman (1998), D’Hemercourt (1998), and Embil (2000).

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