Bayesian Analysis Of Clinical Efficacy Of Recombinant Human Epidermal Growth Factor And Recombinant Human Platelet- Derived Growth Factor In The Treatment Of Diabetic Foot Ulcer

OBJECTIVESOn the basis of Standard Of Care(SOC),two growth factors were used to treat diabetic foot ulcers,with direct and indirect comparison by the Bayesian model.The aim is to provide evidence-based evidence for the prioritization of two cytokines and to provide research directions for future randomized controlled trials.METHODSThrough the literature search of domestic and foreign medical databases,recombinant human epidermal growth factor(rhEGF)and recombinant human plateletderived growth factor(rhPDGF)as the subject words and free words,we searched randomized controlled trials by two methods for the treatment of diabetic foot ulcers(DFUs).The proportion of patients who are completely healed is the main outcome indicator.The estimation of the healing effect is represented by the Odds Ratio(OR)and its 95% Confidence Interval(CI),and the random effects model was used for direct comparison.Direct and indirect comparisons through software Gemtc 0.14.3 with builtin Bayesian model were performed and the possibilities were sorted.RESULTSOf the 11 studies included,there were 1,427 participants and 682 events.Drawing support from Stata15 SE to calculate direct results,summary estimates were made on the efficacy of recombinant human epidermal growth factor(rhEGF)versus placebo(Pla)and recombinant human platelet-derived growth factor(rhPDGF)versus placebo(Pla)with their Odds Ratios(ORs)and 95% Confidence Intervals(CIs)are 2.49 [1.56,3.98] and 1.48 [1.13,1.93] respectively;The Bayesian model software GeMTC 0.14.3 was used to summarize the estimated efficacy ORs and 95% CIs of the above two factors with consistency models 2.67(1.57,5.09)and 1.47(1.00,2.12)respectively and inconsistency models 2.72(1.56,5.07)and 1.46(1.00,2.12)respectively,and the consistency model and inconsistency model in the Bayesian analysis on recombinant human epidermal growth factor(rhEGF)versus recombinant human platelet-derived growth factor(rhPDGF)versus placebo(Pla)are very close,and the Bayesian analysis results can be explained only by using the consistent model results.The indirect comparison on the efficacy between recombinant human epidermal growth factor(rhEGF)and recombinant human platelet-derived growth factor(rhPDGF)in the treatment of diabetic foot ulcers(DFUs)were Odds Ratio(OR)and 95% Confidence Interval(CI)by 1.81(0.25,1.04)in consistency model and 1.83(0.97,3.92)in inconsistency model respectively.The results of direct comparison and Bayesian comparison of recombinant human epidermal growth factor(rhEGF)to placebo(Pla)are consistent and effective.That is,based on Standard Of Care(SOC),recombinant human epidermal growth factor(rhEGF)is significantly effective in the treatment of diabetic foot ulcer(DFUs)to placebo(Pla).The results of direct comparison and Bayesian comparison of recombinant human platelet-derived growth factor(rhPDGF)to placebo(Pla)are consistent and effective.That is,based on Standard Of Care(SOC),recombinant human platelet-derived growth factor(rhPDGF)is significantly effective in the treatment of diabetic foot ulcer(DFUs)to placebo(Pla).Explain the results according to the consistency model of Bayesian analysis results.With the aim of curing diabetic foot ulcers(DFUs),among the three treatments,recombinant human epidermal growth factor(rhEGF)took the first with 97% possibility,recombinant human plateletderived growth factor(rhPDGF)got the second with 94% possibility,and placebo was the third with 97% possibility.CONCLUSIONS1.Recombinant human epidermal growth factor(rhEGF)significantly improved the healing of diabetic foot ulcers(DFUs)when compared to placebo(Pla)based on Standard Of Care(SOC).2.Recombinant human platelet-derived growth factor(rhPDGF)significantly improved the healing of diabetic foot ulcers(DFUs)when compared to placebo(Pla)based on Standard Of Care(SOC).3.Based on Standard Of Care(SOC),recombinant human epidermal growth factor(rhEGF)may be more effective than recombinant human platelet-derived growth factor(rhPDGF)in the treatment of diabetic foot ulcers(DFUs).4.The strength of the assessment results is moderate,but this result may not be applicable to diabetic foot ulcers(DFUs)with infection and/or osteomyelitis,and the results of this study should be carefully considered.