A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers

Tarig Elraiyah, Apostolos Tsapas, Gabriela Prutsky, Juan Pablo Domecq, Rim Hasan, Belal Firwana, Mohammed Nabhan, Larry Prokop, Anil Hingorani, Paul L. Claus, Lawrence W. Steinkraus, Mohammad H Murad

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background Multiple adjunctive therapies have been proposed to accelerate wound healing in patients with diabetes and foot ulcers. The aim of this systematic review is to summarize the best available evidence supporting the use of hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents (pentoxifylline, cilostazol, and iloprost) in this setting. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011. Pairs of independent reviewers selected studies and extracted data. Predefined outcomes of interest were complete wound healing and amputation. Results We identified 18 interventional studies; of which 9 were randomized, enrolling 1526 patients. The risk of bias in the included studies was moderate. In multiple randomized trials, the addition of HBOT to conventional therapy (wound care and offloading) was associated with increased healing rate (Peto odds ratio, 14.25; 95% confidence interval, 7.08-28.68) and reduced major amputation rate (odds ratio, 0.30; 95% confidence interval, 0.10-0.89), compared with conventional therapy alone. In one small trial, arterial pump devices had a favorable effect on complete healing compared with HBOT and in another small trial compared with placebo devices. Neither iloprost nor pentoxifylline had a significant effect on amputation rate compared with conventional therapy. No comparative studies were identified for cilostazol in diabetic foot ulcers. Conclusions There is low- to moderate-quality evidence supporting the use of HBOT as an adjunctive therapy to enhance diabetic foot ulcer healing and potentially prevent amputation. However, there are only sparse data regarding the efficacy of arterial pump devices and pharmacologic interventions.

Original languageEnglish (US)
Pages (from-to)46S-58S
JournalJournal of Vascular Surgery
Volume63
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Diabetic Foot
Hyperbaric Oxygenation
Meta-Analysis
Amputation
Iloprost
Pentoxifylline
Equipment and Supplies
Wound Healing
Odds Ratio
Confidence Intervals
Foot Ulcer
Therapeutics
MEDLINE
Placebos
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. / Elraiyah, Tarig; Tsapas, Apostolos; Prutsky, Gabriela; Domecq, Juan Pablo; Hasan, Rim; Firwana, Belal; Nabhan, Mohammed; Prokop, Larry; Hingorani, Anil; Claus, Paul L.; Steinkraus, Lawrence W.; Murad, Mohammad H.

In: Journal of Vascular Surgery, Vol. 63, No. 2, 01.02.2016, p. 46S-58S.

Research output: Contribution to journalArticle

Elraiyah, T, Tsapas, A, Prutsky, G, Domecq, JP, Hasan, R, Firwana, B, Nabhan, M, Prokop, L, Hingorani, A, Claus, PL, Steinkraus, LW & Murad, MH 2016, 'A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers', Journal of Vascular Surgery, vol. 63, no. 2, pp. 46S-58S. https://doi.org/10.1016/j.jvs.2015.10.007
Elraiyah, Tarig ; Tsapas, Apostolos ; Prutsky, Gabriela ; Domecq, Juan Pablo ; Hasan, Rim ; Firwana, Belal ; Nabhan, Mohammed ; Prokop, Larry ; Hingorani, Anil ; Claus, Paul L. ; Steinkraus, Lawrence W. ; Murad, Mohammad H. / A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. In: Journal of Vascular Surgery. 2016 ; Vol. 63, No. 2. pp. 46S-58S.
@article{0ed50e1d783743538e4952de38f0f74a,
title = "A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers",
abstract = "Background Multiple adjunctive therapies have been proposed to accelerate wound healing in patients with diabetes and foot ulcers. The aim of this systematic review is to summarize the best available evidence supporting the use of hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents (pentoxifylline, cilostazol, and iloprost) in this setting. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011. Pairs of independent reviewers selected studies and extracted data. Predefined outcomes of interest were complete wound healing and amputation. Results We identified 18 interventional studies; of which 9 were randomized, enrolling 1526 patients. The risk of bias in the included studies was moderate. In multiple randomized trials, the addition of HBOT to conventional therapy (wound care and offloading) was associated with increased healing rate (Peto odds ratio, 14.25; 95{\%} confidence interval, 7.08-28.68) and reduced major amputation rate (odds ratio, 0.30; 95{\%} confidence interval, 0.10-0.89), compared with conventional therapy alone. In one small trial, arterial pump devices had a favorable effect on complete healing compared with HBOT and in another small trial compared with placebo devices. Neither iloprost nor pentoxifylline had a significant effect on amputation rate compared with conventional therapy. No comparative studies were identified for cilostazol in diabetic foot ulcers. Conclusions There is low- to moderate-quality evidence supporting the use of HBOT as an adjunctive therapy to enhance diabetic foot ulcer healing and potentially prevent amputation. However, there are only sparse data regarding the efficacy of arterial pump devices and pharmacologic interventions.",
author = "Tarig Elraiyah and Apostolos Tsapas and Gabriela Prutsky and Domecq, {Juan Pablo} and Rim Hasan and Belal Firwana and Mohammed Nabhan and Larry Prokop and Anil Hingorani and Claus, {Paul L.} and Steinkraus, {Lawrence W.} and Murad, {Mohammad H}",
year = "2016",
month = "2",
day = "1",
doi = "10.1016/j.jvs.2015.10.007",
language = "English (US)",
volume = "63",
pages = "46S--58S",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers

AU - Elraiyah, Tarig

AU - Tsapas, Apostolos

AU - Prutsky, Gabriela

AU - Domecq, Juan Pablo

AU - Hasan, Rim

AU - Firwana, Belal

AU - Nabhan, Mohammed

AU - Prokop, Larry

AU - Hingorani, Anil

AU - Claus, Paul L.

AU - Steinkraus, Lawrence W.

AU - Murad, Mohammad H

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background Multiple adjunctive therapies have been proposed to accelerate wound healing in patients with diabetes and foot ulcers. The aim of this systematic review is to summarize the best available evidence supporting the use of hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents (pentoxifylline, cilostazol, and iloprost) in this setting. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011. Pairs of independent reviewers selected studies and extracted data. Predefined outcomes of interest were complete wound healing and amputation. Results We identified 18 interventional studies; of which 9 were randomized, enrolling 1526 patients. The risk of bias in the included studies was moderate. In multiple randomized trials, the addition of HBOT to conventional therapy (wound care and offloading) was associated with increased healing rate (Peto odds ratio, 14.25; 95% confidence interval, 7.08-28.68) and reduced major amputation rate (odds ratio, 0.30; 95% confidence interval, 0.10-0.89), compared with conventional therapy alone. In one small trial, arterial pump devices had a favorable effect on complete healing compared with HBOT and in another small trial compared with placebo devices. Neither iloprost nor pentoxifylline had a significant effect on amputation rate compared with conventional therapy. No comparative studies were identified for cilostazol in diabetic foot ulcers. Conclusions There is low- to moderate-quality evidence supporting the use of HBOT as an adjunctive therapy to enhance diabetic foot ulcer healing and potentially prevent amputation. However, there are only sparse data regarding the efficacy of arterial pump devices and pharmacologic interventions.

AB - Background Multiple adjunctive therapies have been proposed to accelerate wound healing in patients with diabetes and foot ulcers. The aim of this systematic review is to summarize the best available evidence supporting the use of hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents (pentoxifylline, cilostazol, and iloprost) in this setting. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011. Pairs of independent reviewers selected studies and extracted data. Predefined outcomes of interest were complete wound healing and amputation. Results We identified 18 interventional studies; of which 9 were randomized, enrolling 1526 patients. The risk of bias in the included studies was moderate. In multiple randomized trials, the addition of HBOT to conventional therapy (wound care and offloading) was associated with increased healing rate (Peto odds ratio, 14.25; 95% confidence interval, 7.08-28.68) and reduced major amputation rate (odds ratio, 0.30; 95% confidence interval, 0.10-0.89), compared with conventional therapy alone. In one small trial, arterial pump devices had a favorable effect on complete healing compared with HBOT and in another small trial compared with placebo devices. Neither iloprost nor pentoxifylline had a significant effect on amputation rate compared with conventional therapy. No comparative studies were identified for cilostazol in diabetic foot ulcers. Conclusions There is low- to moderate-quality evidence supporting the use of HBOT as an adjunctive therapy to enhance diabetic foot ulcer healing and potentially prevent amputation. However, there are only sparse data regarding the efficacy of arterial pump devices and pharmacologic interventions.

UR - http://www.scopus.com/inward/record.url?scp=84957665899&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84957665899&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2015.10.007

DO - 10.1016/j.jvs.2015.10.007

M3 - Article

C2 - 26804368

AN - SCOPUS:84957665899

VL - 63

SP - 46S-58S

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 2

ER -