title: The evidence for the use of growth factors and active skin substitutes for the treatment of non-infected diabetic foot ulcers (DFU): a health technology assessment (HTA).
abstract: OBJECTIVE
  Assessment of the safety, efficacy and effectiveness of growth factors alone or in combination with other technologies in the treatment of DFU including medical, economical, social, ethical and juridical aspects.
  
  
  METHODS
  We systematically searched relevant data bases limited to English and German language and publications since 1990. Review and assessment of the quality of publications followed methods conforming to widely accepted standards for evidence-based medicine and health economics.
  
  
  RESULTS
  We identified 25 studies comparing becaplermin, rhEGF, bFGF and the metabolically active skin grafts Dermagraft and Apligraf with standard wound care (SWC) alone or extracellular wound matrix. Study duration ranged from 12 to 20 weeks and the study population comprised between 17 and 382 patients. Treatment with becaplermin, rhEGF, Dermagraft and Apligraf resulted in a higher incidence of complete wound closure and shorter time to complete wound healing with statistically significant differences. Regarding the proportion of adverse events there was no difference between treatment groups. The methodological quality of the studies was affected by significant deficiencies. Economic evaluations showed becaplermin being cost-effective.
  
  
  CONCLUSIONS
  Add-on therapy with growth factors and active skin substitutes for treating uncomplicated DFU could be an alternative to SWC alone. For explicit recommendations further studies with stronger evidence are necessary.
authors.affiliation: University of Duisburg-Essen, Essen, Germany. barbara.buchberger@medman.uni-due.de
authors.forename: B
authors.initials: B
authors.lastname: Buchberger
authors.forename: M
authors.initials: M
authors.lastname: Follmann
authors.forename: D
authors.initials: D
authors.lastname: Freyer
authors.forename: H
authors.initials: H
authors.lastname: Huppertz
authors.forename: A
authors.initials: A
authors.lastname: Ehm
authors.forename: J
authors.initials: J
authors.lastname: Wasem
mesh_terms: D003131:Combined Modality Therapy; D017719:Diabetic Foot / Q000188:drug therapy* / Q000191:economics / Q000628:therapy*; D004815:Epidermal Growth Factor / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005346:Fibroblast Growth Factors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D010982:Platelet-Derived Growth Factor / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017768:Skin, Artificial / Q000009:adverse effects / Q000191:economics; D013673:Technology Assessment, Biomedical
chemical_list: D010982:Platelet-Derived Growth Factor; D011994:Recombinant Proteins; D005346:Fibroblast Growth Factors; D004815:Epidermal Growth Factor