Becaplermin: A new effective and safe adjuvant topical therapy in patients with chronic neuropathic diabetic foot ulcer

Abstract

Wound healing is a complex and well coordinated biologic process that involves inflammatory, proliferative and maturation or remodeling phases. A chronic wound results when the normal process of wound healing is interrupted. Diabetic foot ulcer is also a chronic nonhealing wound resulting as a consequence of peripheral neuropathy, local trauma and ischemia. Current research and clinical evidence revealed a fundamental role of growth factors in the biology of wound healing process. Among them one of the most important is the platelet derived growth factor active in the all phases of healing process. Becaplermin (0.01%) is the recombinant human platelet derived growth factor. The biologic activity of becaplermin is similar to native human platelet derived growth factor-BB. Promotion of chemotactic recruitment, as well as the proliferation of cells involved in the wound repair, are the common characteristics of becaplermin and the indigenous human platelet derived growth factor-BB. Becaplermin, topically applied, once daily for 20 weeks or complete healing successfully stimulates the incidence of complete wound closure and decreases the time of complete wound closure of neuropathic diabetic foot ulcer. To ensure that efficacy and healing of diabetic foot ulcers using becaplermin it is essential to ensure adequate peripheral circulation (transcutaneous partial pressure of oxygen pressure at least or more than 30mmHg on the foot dorsum or at the margin of ulcer), sharp debridment, pressure relief and local infection control. Topical becaplermin has no serious local or systemic unwonted effects. The systemic absorption appears to be minimal, it does not produce cancer at the site of application and fibrosis and it does not worsen diabetic neuropathy.