Epidermal growth factor outperforms placebo in the treatment of diabetic foot ulcer: a meta-analysis

Fazal Rahim; Xie Yan; Jawad Ali Shah; Nida Bibi; Zafar Ullah Khan; Shah Nawaz; Yao Ming

doi:10.12688/f1000research.121712.2

Epidermal growth factor outperforms placebo in the treatment of diabetic foot ulcer: a meta-analysis

F1000Res. 2023 Mar 10:11:773. doi: 10.12688/f1000research.121712.2. eCollection 2022.

Authors

Fazal Rahim¹, Xie Yan^{2

3}, Jawad Ali Shah⁴, Nida Bibi⁵, Zafar Ullah Khan⁶, Shah Nawaz⁷, Yao Ming¹

Affiliations

¹ Burn and Plastic Surgery department, General Hospital of Ningxia Medical University, Yinchuan, P.R. China, Yinchuan, 750004, China.
² School of Biomedical Sciences, Faculty of Health, Queensland University of technology, Brisbane, Australia., Brisbane, 4072, Australia.
³ Tissue Organ Bank & Tissue Engineering Center, General Hospital of Ningxia Medical University, Yinchuan, P.R. China, Yinchuan, 750004, China.
⁴ Laboratory of Ecology and Evolutionary Biology, and Yunnan Key Laboratory of Plant Reproductive Adaption and Evolutionary Ecology, Yunnan University, Kunming, 650500, China.
⁵ Department of zoology, Shaheed Benazir Bhutto University, Sheringal 18000, Pakistan., Dir upper, 18000, Pakistan.
⁶ The second affiliated Hospital, School of Medicine, Zhejiang University 310058, P.R China, Zhejiang, China.
⁷ Department of infectious diseases, General Hospital of Ningxia Medical University, Yinchuan, P.R. China, Yinchuan, 750004, China.

Abstract

Background: Diabetic foot ulcers (DFUs) are a life-threatening ailment caused by diabetes. Several growth factors, as well as their various combinations, have shown promising effect in aiding diabetic foot ulcer healing. However, contradictory or paradoxical results are often available, and debates about this issue are ongoing. Therefore, a comprehensive meta-analysis was performed to compare the efficacy and safety of epidermal growth factor (EGF) and placebo in healing diabetic foot ulcers. Methods: The database search included relevant English literature from Cochrane Library, PubMed, Google Scholar, Elsevier, and EMBASE that was published between 2009 and 2021. Inclusion criteria included type 1 and 2 diabetic patients with foot wounds focusing on complete healing rate. Exclusion criteria included combined therapy, non-human studies, reviews, and protocols. To assess the quality of each study, biases regarding random sequence generation, allocation concealment, participant and personnel blinding, outcome assessment blinding and incomplete outcome data were thoroughly identified. Results: Eight randomized control trials comprising 620 patients (337 in EGF group, 283 in placebo group), were included in this meta-analysis. EGF achieved a significantly higher complete healing rate than placebo after four weeks of treatment, with relative risk (RR): 3.04 (0.50, 18.44) and heterogeneity (Chi ² = 6.46, df = 2 (P = 0.04) I ² = 69 %). Notably, the healing frequency in the placebo group was 17%, whereas the healing frequency in the epidermal growth factor group was 34%. Likewise, after eight weeks of treatment, the relative risk and heterogeneity were RR: 2.59 (1.42, 4.72) and (Chi ² =7.92, df= 4 (p= 0.09): I ²= 49%), respectively. Moreover, the risk ratio at 12 weeks was RR: 1.01 (0.42, 2.46), and heterogeneity was (Chi ² =8.55, df= 2 (p= 0.01): I ²= 77%). Conclusions: Our findings indicate that EGF significantly promotes wound healing, and could be recommended as an effective and safe treatment for DFUs.

Keywords: Diabetic foot ulcer; Meta-analysis; Placebo; epidermal growth factor.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Mellitus*
Diabetic Foot* / drug therapy
Epidermal Growth Factor / pharmacology
Epidermal Growth Factor / therapeutic use
Humans
Randomized Controlled Trials as Topic
Wound Healing

Substances

Epidermal Growth Factor

Associated data

figshare/10.6084/m9.figshare.19928645

Grants and funding

This work was supported by key Research & development projects of Ningxia Hui Autonomous region at Ningxia medical university 2019, under the Grant number: 2019BEG03069.