hEGF is Superior to Placental Extract for Diabetic Foot Ulcers
Based on the available evidence, human epidermal growth factor (hEGF) should be used over placental extract for treating diabetic foot ulcers, as hEGF has robust clinical trial data demonstrating significant healing benefits, while no evidence exists supporting placental extract for this indication.
Evidence Supporting hEGF
Efficacy Data
Topical hEGF demonstrates a 54% improvement in healing rates compared to standard care alone, with the pooled analysis of 7 randomized controlled trials showing a risk ratio of 1.54 (95% CI 1.30-1.83) for complete wound healing 1.
The most compelling evidence comes from concentration-dependent effects:
- 0.04% hEGF concentration achieves 95% complete healing rates within 12 weeks, compared to only 42% in control groups 2
- Lower concentrations (0.02%) show intermediate results with 57% healing rates 2
- The higher concentration significantly reduces healing time based on Kaplan-Meier analysis (P = 0.0003) 2
Application Methods
For Wagner grade 1-2 ulcers, topical application is preferred with a risk ratio of 1.61 (95% CI 1.32-1.97) and no significant adverse effects 1.
For Wagner grade 2-3 ulcers, intralesional injection (Heberprot-p 75μg) demonstrates superior outcomes with shorter treatment times and higher healing rates, though it carries increased risk of shivering (RR 4.67) and nausea/vomiting (RR 2.18) 1, 3.
Clinical Outcomes
The evidence demonstrates:
- Complete healing in 76% of EGF-treated patients (52 of 68) within an average of 46 days when combined with advanced dressings 4
- Meta-analysis shows combined odds ratio of 4.36 (95% CI 1.48-12.81, P = 0.007) favoring hEGF over placebo 5
- No recurrence noted during 6-month follow-up periods 4
Absence of Evidence for Placental Extract
No research evidence was identified supporting the use of placental extract for diabetic foot ulcers. This represents a critical gap—without randomized controlled trials or systematic reviews demonstrating efficacy, placental extract cannot be recommended for this indication.
Practical Implementation Algorithm
- Confirm diabetic foot ulcer diagnosis and classify Wagner grade
- For Wagner 1-2 ulcers: Apply topical 0.04% hEGF twice daily with advanced dressing 2
- For Wagner 2-3 ulcers: Consider intralesional Heberprot-p 75μg as adjunct to standard care 3
- Reassess at 3 weeks: If minimal improvement with standard dressing alone, crossover to hEGF therapy 4
- Continue treatment up to 12 weeks with biweekly multidisciplinary assessment 2
Important Caveats
- Intralesional injection requires monitoring for systemic symptoms including shivering and gastrointestinal effects, though these are generally mild 1
- hEGF must be combined with appropriate wound debridement and advanced dressings—it is not monotherapy 4
- New lesions may develop at different sites despite successful healing of the original ulcer (observed in 5 of 52 healed patients) 4