Advanced biological therapies for diabetic foot ulcers

Robert Kirsner, Robert Warriner, Michelle Michela, Laure Stasik, Katherine Freeman

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: To assess the clinical use of advanced biological therapies in treating diabetic foot ulcers in practice and the effect of these therapies on time to healing. Design: A retrospective cohort study. Setting: A validated wound care database from January 1, 2001, through December 31, 2004. Participants: Two thousand five hundred seventeen patients with diabetic neuropathic foot ulcers. Intervention: Patients who received advanced biological therapy (ie, Apligraf, Regranex, or Procuren). Main Outcome Measure: Time to healing after initial use of advanced biological therapy. This was derived using Kaplan-Meier estimates and the Ederer least squares method after adjusting for covariates, which were assessed using generalized estimating equations and Cox proportional hazards regression modeling. Results: Advanced biological therapy was used, on average, within 28 days from the first wound clinic visit and associated with a median time to healing of 100 days. Regardless of the advanced biological therapy used, wounds with larger wound area, more severe wound grades, longer duration of wound prior to the first visit, and prolonged time to treatment with advanced biological therapies were significantly associated with longer time to healing. Wounds treated with engineered skin as the first advanced biological therapy were 31.2% more likely to heal than wounds first treated with topical recombinant growth factor (P<.001), and 40.0% more likely to heal than those first treated with platelet releasate (P=.01). Woundsize, wound grade, duration of wound, and time to initiation of advanced biological therapy affected the time to healing. Conclusions: Advanced biological therapies were used, on average, within 1 month, and improved healing of refractory diabetic foot ulcers. Differences on outcomes among advanced biological therapies were noted.

Original languageEnglish
Pages (from-to)857-862
Number of pages6
JournalArchives of Dermatology
Volume146
Issue number8
DOIs
StatePublished - Aug 1 2010

Fingerprint

Biological Therapy
Diabetic Foot
Wounds and Injuries
Kaplan-Meier Estimate
Ambulatory Care
Least-Squares Analysis
Intercellular Signaling Peptides and Proteins
Cohort Studies
Blood Platelets
Retrospective Studies
Outcome Assessment (Health Care)
Databases
Skin

ASJC Scopus subject areas

  • Dermatology

Cite this

Advanced biological therapies for diabetic foot ulcers. / Kirsner, Robert; Warriner, Robert; Michela, Michelle; Stasik, Laure; Freeman, Katherine.

In: Archives of Dermatology, Vol. 146, No. 8, 01.08.2010, p. 857-862.

Research output: Contribution to journalArticle

Kirsner, R, Warriner, R, Michela, M, Stasik, L & Freeman, K 2010, 'Advanced biological therapies for diabetic foot ulcers', Archives of Dermatology, vol. 146, no. 8, pp. 857-862. https://doi.org/10.1001/archdermatol.2010.164
Kirsner, Robert ; Warriner, Robert ; Michela, Michelle ; Stasik, Laure ; Freeman, Katherine. / Advanced biological therapies for diabetic foot ulcers. In: Archives of Dermatology. 2010 ; Vol. 146, No. 8. pp. 857-862.
@article{9fc4c6f8de704a77877760366e33ffd6,
title = "Advanced biological therapies for diabetic foot ulcers",
abstract = "Objective: To assess the clinical use of advanced biological therapies in treating diabetic foot ulcers in practice and the effect of these therapies on time to healing. Design: A retrospective cohort study. Setting: A validated wound care database from January 1, 2001, through December 31, 2004. Participants: Two thousand five hundred seventeen patients with diabetic neuropathic foot ulcers. Intervention: Patients who received advanced biological therapy (ie, Apligraf, Regranex, or Procuren). Main Outcome Measure: Time to healing after initial use of advanced biological therapy. This was derived using Kaplan-Meier estimates and the Ederer least squares method after adjusting for covariates, which were assessed using generalized estimating equations and Cox proportional hazards regression modeling. Results: Advanced biological therapy was used, on average, within 28 days from the first wound clinic visit and associated with a median time to healing of 100 days. Regardless of the advanced biological therapy used, wounds with larger wound area, more severe wound grades, longer duration of wound prior to the first visit, and prolonged time to treatment with advanced biological therapies were significantly associated with longer time to healing. Wounds treated with engineered skin as the first advanced biological therapy were 31.2{\%} more likely to heal than wounds first treated with topical recombinant growth factor (P<.001), and 40.0{\%} more likely to heal than those first treated with platelet releasate (P=.01). Woundsize, wound grade, duration of wound, and time to initiation of advanced biological therapy affected the time to healing. Conclusions: Advanced biological therapies were used, on average, within 1 month, and improved healing of refractory diabetic foot ulcers. Differences on outcomes among advanced biological therapies were noted.",
author = "Robert Kirsner and Robert Warriner and Michelle Michela and Laure Stasik and Katherine Freeman",
year = "2010",
month = "8",
day = "1",
doi = "10.1001/archdermatol.2010.164",
language = "English",
volume = "146",
pages = "857--862",
journal = "JAMA Dermatology",
issn = "2168-6068",
publisher = "American Medical Association",
number = "8",

}

TY - JOUR

T1 - Advanced biological therapies for diabetic foot ulcers

AU - Kirsner, Robert

AU - Warriner, Robert

AU - Michela, Michelle

AU - Stasik, Laure

AU - Freeman, Katherine

PY - 2010/8/1

Y1 - 2010/8/1

N2 - Objective: To assess the clinical use of advanced biological therapies in treating diabetic foot ulcers in practice and the effect of these therapies on time to healing. Design: A retrospective cohort study. Setting: A validated wound care database from January 1, 2001, through December 31, 2004. Participants: Two thousand five hundred seventeen patients with diabetic neuropathic foot ulcers. Intervention: Patients who received advanced biological therapy (ie, Apligraf, Regranex, or Procuren). Main Outcome Measure: Time to healing after initial use of advanced biological therapy. This was derived using Kaplan-Meier estimates and the Ederer least squares method after adjusting for covariates, which were assessed using generalized estimating equations and Cox proportional hazards regression modeling. Results: Advanced biological therapy was used, on average, within 28 days from the first wound clinic visit and associated with a median time to healing of 100 days. Regardless of the advanced biological therapy used, wounds with larger wound area, more severe wound grades, longer duration of wound prior to the first visit, and prolonged time to treatment with advanced biological therapies were significantly associated with longer time to healing. Wounds treated with engineered skin as the first advanced biological therapy were 31.2% more likely to heal than wounds first treated with topical recombinant growth factor (P<.001), and 40.0% more likely to heal than those first treated with platelet releasate (P=.01). Woundsize, wound grade, duration of wound, and time to initiation of advanced biological therapy affected the time to healing. Conclusions: Advanced biological therapies were used, on average, within 1 month, and improved healing of refractory diabetic foot ulcers. Differences on outcomes among advanced biological therapies were noted.

AB - Objective: To assess the clinical use of advanced biological therapies in treating diabetic foot ulcers in practice and the effect of these therapies on time to healing. Design: A retrospective cohort study. Setting: A validated wound care database from January 1, 2001, through December 31, 2004. Participants: Two thousand five hundred seventeen patients with diabetic neuropathic foot ulcers. Intervention: Patients who received advanced biological therapy (ie, Apligraf, Regranex, or Procuren). Main Outcome Measure: Time to healing after initial use of advanced biological therapy. This was derived using Kaplan-Meier estimates and the Ederer least squares method after adjusting for covariates, which were assessed using generalized estimating equations and Cox proportional hazards regression modeling. Results: Advanced biological therapy was used, on average, within 28 days from the first wound clinic visit and associated with a median time to healing of 100 days. Regardless of the advanced biological therapy used, wounds with larger wound area, more severe wound grades, longer duration of wound prior to the first visit, and prolonged time to treatment with advanced biological therapies were significantly associated with longer time to healing. Wounds treated with engineered skin as the first advanced biological therapy were 31.2% more likely to heal than wounds first treated with topical recombinant growth factor (P<.001), and 40.0% more likely to heal than those first treated with platelet releasate (P=.01). Woundsize, wound grade, duration of wound, and time to initiation of advanced biological therapy affected the time to healing. Conclusions: Advanced biological therapies were used, on average, within 1 month, and improved healing of refractory diabetic foot ulcers. Differences on outcomes among advanced biological therapies were noted.

UR - http://www.scopus.com/inward/record.url?scp=77955883406&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955883406&partnerID=8YFLogxK

U2 - 10.1001/archdermatol.2010.164

DO - 10.1001/archdermatol.2010.164

M3 - Article

C2 - 20713816

AN - SCOPUS:77955883406

VL - 146

SP - 857

EP - 862

JO - JAMA Dermatology

JF - JAMA Dermatology

SN - 2168-6068

IS - 8

ER -