Chronic wounds are estimated to affect over 6 million people annually in the United
States with an estimated annual cost of $25 billion. Debridement represents a key
step in their management and is considered a basic necessity to induce the functional
process of tissue repair. However, there is an unmet need for an efficient rapid acting
non-surgical debridement agent. Bromelain-based enzymatic debridement has been proven
to provide an effective, selective and safe non-surgical debridement in deep burns.
EscharEx (MediWound Ltd, Yavne, Israel), is a bromelain-based enzymatic debridement
agent currently in development for chronic wounds. The aim of this study was to assess
its safety and efficacy in chronic wounds. Seventy-three patients suffering from a
lower extremity ulcer of diabetic/venous insufficiency/post-surgical/traumatic aetiology
were enrolled in a multicentre, assessor blinded, randomized controlled trial. Patients
were randomized to topical treatment by either EscharEx or its gel vehicle for up
to 10 daily 4 hour applications, and then continued follow-up for up to 6 months.
The EscharEx arm achieved a significantly higher incidence of complete debridement
compared to the gel vehicle arm; 55 versus 29% (p = .047), thus meeting the primary
endpoint of this study. The EscharEx and gel vehicle arms achieved similar reductions
in wound area, non-viable tissue area and wound healing scores during the debridement
period. There were no significant differences between the arms in the incidence of
complete wound closure (41% in the EsxcharEx arm vs. 53% in the gel vehicle arm) and
in the mean time to complete wound closure (70.0 +/- 32.8 days in the EsxcharEx arm
vs. 65.7 +/- 38.4 days in gel vehicle arm). There were no significant safety issues
and EscharEx demonstrated a favourable benefit to risk profile.
