Anacaulase-bcdb for the treatment of severe thermal burns

ABSTRACT

Introduction

Accurate burn depth assessment and early excision of burn eschar with maximal dermal preservation are key concepts in the optimal care of burn injury. Although excision with knife has long since been standard of care, a newer technique for wound bed preparation utilizing a bromelain-based enzyme has gained popularity worldwide and may offer several advantages.

Areas covered

Here we report the pharmacologic properties, evidence for clinical efficacy, safety, and tolerability of anacaulase-bcdb for the treatment of deep partial thickness and full thickness burns.

Expert opinion

Anacaulase-bcdb is a safe, non-surgical, selective eschar removal agent. It offers advantages over surgical excision of burn with knife and fulfills two unmet needs: burn depth assessment and dermal preservation during excision. Evidence supports a faster time to complete eschar removal; reduced number of operations; reduction in the amount of autografting, length of stay, and blood loss; prevention of burn induced compartment syndrome; and improved cosmetic outcome.

KEYWORDS:

• Anacaulase-bcdb
• bromelain
• burn
• enzymatic debridement
• NexoBrid
• thermal

Article highlights

• Surgical escharectomy remains the mainstay of treatment for deep burns, but has associated complications, high operating room (OR) costs, utilization of human resources, and may not maximally preserve critical, viable dermal elements.

• Anacaulase-bcdb is a topically applied, pineapple stem-derived, Bromelain-based debridement (BBD) concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) approved for use in 44 countries.

• Anacaulase-bcdb can remove all non-viable tissue (burn eschar) in 4 hours, while maximally preserving the viable underlying dermis; and allows for the visualization of the remaining viable wound bed and better estimation of its potential to spontaneously regenerate.

• A large body of evidence, including three RCTs, demonstrates that anacaulase-bcdb is safe, fast, effective, and highly selective. Benefits include faster time to complete eschar removal, faster healing time, reduced need for autografting, reduced size of required autograft, and reduced blood loss.

• Treatment can be painful and therefore requires appropriate analgesia. The most common adverse reactions noted in clinical trials were pruritis and pyrexia.

• Anacaulase-bcdb is currently routinely used by many European burn centers for treatment of deep thermal burns in adults but additional long-term data on scarring outcomes as well as data on cost-efficacy are needed.

Declaration of interests

Y Shoham has acted as an independent consultant for Vericel and Mediwound. J Goverman has acted as an independent consultant for Vericel. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Scientific accuracy review

MediWound provided a scientific accuracy review at the request of the journal editor.

Additional information

Funding

This paper was not funded.