1
|
Mahlapuu M, Sidorowicz A, Mikosinski J, Krzyżanowski M, Orleanski J, Twardowska-Saucha K, Nykaza A, Dyaczynski M, Belz-Lagoda B, Dziwiszek G, Kujawiak M, Karczewski M, Sjöberg F, Grzela T, Wegrzynowski A, Thunarf F, Björk J, Ekblom J, Jawien A, Apelqvist J. Evaluation of LL-37 in healing of hard-to-heal venous leg ulcers: A multicentric prospective randomized placebo-controlled clinical trial. Wound Repair Regen 2021; 29:938-950. [PMID: 34687253 PMCID: PMC9298190 DOI: 10.1111/wrr.12977] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/27/2021] [Accepted: 10/05/2021] [Indexed: 12/01/2022]
Abstract
Many patients with venous leg ulcers do not reach complete healing with compression treatment alone, which is current standard care. This clinical trial HEAL LL‐37 was a phase IIb double‐blind, randomized, placebo‐controlled study, with the aim to evaluate the efficacy and safety of a new drug LL‐37 for topical administration, in combination with compression therapy, in 148 patients suffering from hard‐to‐heal venous leg ulcers. The study had three arms, consisting of two groups treated with LL‐37 at concentrations of 0.5 or 1.6 mg/mL, and a placebo cohort. Patients had a mean age of 67.6 years, a median ulcer duration of 20.3 months, and a mean wound size at the time of randomization of 11.6 cm2. Efficacy analysis performed on the full study population did not identify any significant improvement in healing in patients treated with LL‐37 as compared with the placebo. In contrast, a post hoc analysis revealed statistically significant improvement with LL‐37 treatment in several interrelated healing parameters in the subgroup of patients with large target wounds (a wound area of at least 10 cm2 at randomization), which is a known negative prognostic factor for healing. The study drug was well tolerated and safe in both dose strengths. In summary, this clinical trial did not detect any significant differences in healing of venous lower leg ulcers in the entire study cohort comparing patients treated with LL‐37 versus placebo. A subgroup analysis provided an interesting observation that LL‐37 could offer a treatment benefit in patients with large ulcers, exigently warranting a further study adequately powered to statistically assess the treatment outcome in this patient group.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Folke Sjöberg
- Burn Center, Linköping University Hospital, Linköping, Sweden
| | - Tomasz Grzela
- Clinic of Phlebology and the Medical University of Warsaw, Warsaw, Poland
| | | | | | | | | | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
| |
Collapse
|
3
|
Klek S, Pawlowska D, Dziwiszek G, Komon H, Compala P, Nawojski M. THE EVOLUTION OF HOME ENTERAL NUTRITION (HEN) IN POLAND DURING FIVE YEARS AFTER IMPLEMENTATION: A MULTICENTRE STUDY. NUTR HOSP 2015; 32:196-201. [PMID: 26262717 DOI: 10.3305/nh.2015.32.1.8819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND home enteral nutrition (HEN) is the best option for chronic. patients without the ability to swallow, but with intact digestive tract. Despite the increasing use of home enteral tube feeding (HETF), there is little published information about the types of patients receiving home enteral nutrition. The purpose of this paper to present the evolution of HETF. MATERIAL AND METHODS the retrospective multicenter observational study was performed using questionnaires, which were distributed among the biggest Polish HEN centres. The study covered all patients treated between January, 2007 and January, 2014. RESULTS in total 196 adult patients in 2008 (M:104. F: 92, mean age 58.1 [41-75]) and 2842 in 2013 (M: 1541, F: 1301, mean age 61.4 range: 1-91) were assessed. The number of patients grew significantly between 2008 and 2013 (p < 0.05), rising from 196 up to 2 842 (and 1 716 at the moment of study). The predominant primary disease was neurology in both time periods, but the profile switched from neurovascular to neurodegenerative (p > 0.05). Percutaneous endoscopic gastrostomy was the most common GI access ( > 60%), its use and the use of gastrostomies increased significantly since 2008 (p < 0.05). Although the reimbursement for HETF started in 2007, HEN centres expressed doubts about unclear rules for the qualification to HEN and its use. CONCLUSIONS HETF is a safe, well-tolerated and cost-effective procedure. The profile of patients and techniques may vary at the beginning, but becomes similar to other HETF countries relatively soon. The number of patients grows quickly, and that fact suggests that the prevalence of HETF is similar in all countries.
Collapse
Affiliation(s)
- Stanislaw Klek
- Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina..
| | | | | | - Henryk Komon
- Home Enteral Nutrition Unit, Stomed, Ostroleka..
| | | | | |
Collapse
|
6
|
Klek S, Hermanowicz A, Dziwiszek G, Matysiak K, Szczepanek K, Szybinski P, Galas A. Home enteral nutrition reduces complications, length of stay, and health care costs: results from a multicenter study. Am J Clin Nutr 2014; 100:609-15. [PMID: 24965306 DOI: 10.3945/ajcn.113.082842] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Home enteral nutrition (HEN) has always been recognized as a life-saving procedure, but with the ongoing economic crisis influencing health care, its cost-effectiveness has been questioned recently. OBJECTIVE The unique reimbursement situation in Poland enabled the otherwise ethically unacceptable, hence unavailable, comparison of the period of no-feeding and long-term feeding and the subsequent analyses of the clinical value of the latter and its cost-effectiveness. DESIGN The observational multicenter study in the group of 456 HEN patients [142 children: 55 girls and 87 boys, mean (±SD) age 8.7 ± 5.9 y; 314 adults: 151 women and 163 men, mean age 59.3 ± 19.8 y] was performed between January 2007 and July 2013. Two 12-mo periods were compared. During the first period, patients were tube fed a homemade diet and were not monitored; during the other period, patients received HEN. HEN included tube feeding and complex monitoring by a nutrition support team. The number of complications, hospital admissions, length of hospital stay, biochemical and anthropometric variables, and costs of hospitalization were compared. RESULTS Implementation of HEN enabled weight gain and stabilized liver function in both age groups, but it hardly influenced the other tests. HEN implementation reduced the incidence of infectious complications (37.4% compared with 14.9%; P < 0.001, McNemar test), the number of hospital admissions [1.98 ± 2.42 (mean ± SD) before and 1.26 ± 2.18 after EN; P < 0.001, Wilcoxon's signed-rank test], and length of hospital stay (39.7 ± 71.9 compared with 11.9 ± 28.5 d; P < 0.001, Wilcoxon's signed-rank test). The mean annual costs ($) of hospitalization were reduced from 6500.20 ± 10,402.69 to 2072.58 ± 5497.00. CONCLUSIONS The study showed that HEN improves clinical outcomes and decreases health care costs. It was impossible, however, to determine precisely which factor mattered more: the artificial diet itself or the introduction of complex care.
Collapse
Affiliation(s)
- Stanislaw Klek
- From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG)
| | - Adam Hermanowicz
- From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG)
| | - Grzegorz Dziwiszek
- From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG)
| | - Konrad Matysiak
- From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG)
| | - Kinga Szczepanek
- From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG)
| | - Piotr Szybinski
- From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG)
| | - Aleksander Galas
- From Stanley Dudrick's Memorial Hospital, General and Oncology Surgery Unit, Skawina, Poland (SK, KS, and PS); the Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland (AH); the Home Enteral Nutrition Unit, Stomed, Ostroleka, Poland (GD); Gastroenterology and Oncology and Plastic Surgery, Medical University of Poznan, Poznan, Poland (KM); and Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland (AG)
| |
Collapse
|