TLC-NOSF dressings as a first-line local treatment of chronic wounds: a systematic review of clinical evidence.

IF 1.5 4区 医学 Q3 DERMATOLOGY
Marco Meloni, Hester Colboc, David G Armstrong, Joachim Dissemond, Gerry Rayman, José-Luis Lázaro-Martínez, Rodrigo Rial, Agnès Hartemann, Leanne Atkin, Terry Swanson, Michele Goodeve, Ralf Lobmann, Martin Storck, Knut Kröger, Sebastian Borys, Harikrishna Kr Nair, Sanjay Vaidya, Thua Nguyen Tran, Bao Le Thai Huynh, Laetitia Thomassin, Serge Bohbot, Chris Manu, Sylvie Meaume
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引用次数: 0

Abstract

Objective: Several national and international guidelines recommend lipidocolloid technology with a nano-oligosaccharide factor (TLC-NOSF) dressings (UrgoStart dressing range, Laboratoires Urgo, France) for treating patients with chronic wounds. However, these dressings are still often reported as second-line options, potentially leading to loss of opportunity for patients and additional costs for payers. This review aimed to explore the reported wound healing and patient outcomes as well as the related costs when the dressings were used as first-line treatment in patients with different types of chronic wounds.

Method: A systematic review of the literature was conducted. Databases (MEDLINE, Embase, Emcare, and Google Scholar) were searched up to 1 February 2024, without any language or time period limitations. Studies were eligible if the evaluated dressings had been used as a first-line treatment for chronic wounds, that is, as an integral part of the standard of care (SoC) at the patient's first presentation and/or in recent wounds. The main evaluation criteria included: wound healing rate; time to reach wound closure; change in patients' quality of life (QoL); and associated costs. The quality of evidence of the included studies was appraised using well-recognised risk-of-bias tools suitable for different study designs. A narrative synthesis describes the findings in three sections depending on the type of comparison. This report followed the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: A total of 17 studies published between 2017 and 2024 met the eligibility criteria. A comparative analysis between TLC-NOSF dressings and standard dressings, both of which were used as first-line treatment, was reported in nine studies. A comparative analysis between the use of TLC-NOSF dressings as first-line and second-line treatments was reported in eight studies, and five studies reported a systematic use of the TLC-NOSF dressing as first-line treatment without a control group. Overall, the included studies had a relatively low risk of bias for the respective types of evidence. Data of 10,191 patients of both sexes and different age groups with a total of 10,203 wounds (diabetic foot ulcers, leg ulcers, pressure injuries, and other types of chronic wounds) were included in the analysis: 7775 treated with the evaluated dressing and 2428 treated with a comparator dressing. The data suggested that using TLC-NOSF as a first-line treatment for chronic wounds consistently resulted in significantly higher healing rates, shorter healing times, and cost savings compared with standard dressings used under similar conditions. Real-life evidence confirmed the results obtained in clinical trials and economic models, within similar ranges, regardless of the settings involved or of the characteristics of the patients and wounds treated. The wound healing rates ranged around 70-80% by week 20/24 and time-to-heal was reported on average around seven weeks, with slightly longer times reported in wounds with a more severe prognosis. Furthermore, the dressings were shown to improve patient QoL, and were well tolerated and accepted, supporting a wider adoption approach.

Conclusion: The results of this review are aligned with the current guidelines recommending the use of TLC-NOSF dressings in the treatment of patients with chronic wounds. They support its wider implementation as a first-line treatment and as an integral part of SoC for these wounds in the daily practice of all centres involved in their management.

将 TLC-NOSF 敷料作为慢性伤口的一线局部治疗方法:临床证据系统回顾。
目的:一些国家和国际指南推荐使用含纳米寡糖因子(TLC-NOSF)的脂质胶体技术敷料(UrgoStart 敷料系列,法国 Urgo 实验室)治疗慢性伤口患者。然而,据报道,这些敷料仍经常被作为二线选择,可能导致患者失去治疗机会,而支付者则需要支付额外费用。本综述旨在探讨不同类型慢性伤口患者将敷料作为一线治疗时的伤口愈合情况、患者疗效以及相关费用:方法:对文献进行了系统回顾。对截至 2024 年 2 月 1 日的数据库(MEDLINE、Embase、Emcare 和 Google Scholar)进行了检索,没有任何语言或时间段限制。如果所评估的敷料被用作慢性伤口的一线治疗,即在患者首次就诊时和/或近期伤口中作为标准护理(SoC)的组成部分,则符合研究条件。主要评估标准包括:伤口愈合率、伤口闭合时间、患者生活质量(QoL)的变化以及相关费用。纳入研究的证据质量采用公认的适用于不同研究设计的偏倚风险工具进行评估。叙述性综述根据比较类型将研究结果分为三个部分。本报告遵循了《系统综述和元分析首选报告项目》指南的原则:2017年至2024年间发表的共17项研究符合资格标准。9项研究对TLC-NOSF敷料和标准敷料进行了比较分析,这两种敷料都被用作一线治疗。8项研究报告了将TLC-NOSF敷料作为一线治疗和二线治疗的对比分析,5项研究报告了将TLC-NOSF敷料作为一线治疗的系统性使用,但未设对照组。总体而言,纳入的研究在各自的证据类型中偏倚风险相对较低。共有 10,191 名男女患者和不同年龄组的 10,203 例伤口(糖尿病足溃疡、腿部溃疡、压力性损伤和其他类型的慢性伤口)的数据被纳入分析:7775 例患者使用了评估过的敷料,2428 例患者使用了对比敷料。数据表明,与类似条件下使用的标准敷料相比,将 TLC-NOSF 作为慢性伤口的一线治疗方法可显著提高愈合率、缩短愈合时间并节约成本。现实生活中的证据证实了临床试验和经济模型中获得的结果,无论涉及的环境或所治疗的患者和伤口的特征如何,结果都在相似的范围内。到第 20/24 周时,伤口愈合率约为 70-80%,平均愈合时间约为七周,预后较差的伤口愈合时间稍长。此外,敷料还能改善患者的生活质量,而且患者的耐受性和接受度都很好,因此支持更广泛地采用这种方法:本综述的结果与建议使用 TLC-NOSF 敷料治疗慢性伤口患者的现行指南一致。这些结果支持将 TLC-NOSF 作为一线治疗方法,并在所有参与伤口管理的中心的日常工作中将其作为 SoC 的组成部分加以广泛应用。
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来源期刊
Journal of wound care
Journal of wound care DERMATOLOGY-
CiteScore
2.90
自引率
10.50%
发文量
215
期刊介绍: Journal of Wound Care (JWC) is the definitive wound-care journal and the leading source of up-to-date research and clinical information on everything related to tissue viability. The journal was first launched in 1992 and aimed at catering to the needs of the multidisciplinary team. Published monthly, the journal’s international audience includes nurses, doctors and researchers specialising in wound management and tissue viability, as well as generalists wishing to enhance their practice. In addition to cutting edge and state-of-the-art research and practice articles, JWC also covers topics related to wound-care management, education and novel therapies, as well as JWC cases supplements, a supplement dedicated solely to case reports and case series in wound care. All articles are rigorously peer-reviewed by a panel of international experts, comprised of clinicians, nurses and researchers. Specifically, JWC publishes: High quality evidence on all aspects of wound care, including leg ulcers, pressure ulcers, the diabetic foot, burns, surgical wounds, wound infection and more The latest developments and innovations in wound care through both preclinical and preliminary clinical trials of potential new treatments worldwide In-depth prospective studies of new treatment applications, as well as high-level research evidence on existing treatments Clinical case studies providing information on how to deal with complex wounds Comprehensive literature reviews on current concepts and practice, including cost-effectiveness Updates on the activities of wound care societies around the world.
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