Bromelain-based enzymatic debridement of chronic wounds: Results of a multicentre randomized controlled trial

Yaron Shoham, Eyal Shapira, Josef Haik, Moti Harats, Dana Egozi, Dror Robinson, Leonid Kogan, Rania Elkhatib, Geza Telek, Avshalom Shalom

    Research output: Contribution to journalArticlepeer-review

    7 Scopus citations


    Chronic wounds are estimated to affect over 6 million people annually in the United States with an estimated annual cost of $25 billion. Debridement represents a key step in their management and is considered a basic necessity to induce the functional process of tissue repair. However, there is an unmet need for an efficient rapid acting non-surgical debridement agent. Bromelain-based enzymatic debridement has been proven to provide an effective, selective and safe non-surgical debridement in deep burns. EscharEx (MediWound Ltd, Yavne, Israel), is a bromelain-based enzymatic debridement agent currently in development for chronic wounds. The aim of this study was to assess its safety and efficacy in chronic wounds. Seventy-three patients suffering from a lower extremity ulcer of diabetic/venous insufficiency/post-surgical/traumatic aetiology were enrolled in a multicentre, assessor blinded, randomized controlled trial. Patients were randomized to topical treatment by either EscharEx or its gel vehicle for up to 10 daily 4 hour applications, and then continued follow-up for up to 6 months. The EscharEx arm achieved a significantly higher incidence of complete debridement compared to the gel vehicle arm; 55 versus 29% (p =.047), thus meeting the primary endpoint of this study. The EscharEx and gel vehicle arms achieved similar reductions in wound area, non-viable tissue area and wound healing scores during the debridement period. There were no significant differences between the arms in the incidence of complete wound closure (41% in the EsxcharEx arm vs. 53% in the gel vehicle arm) and in the mean time to complete wound closure (70.0 ± 32.8 days in the EsxcharEx arm vs. 65.7 ± 38.4 days in gel vehicle arm). There were no significant safety issues and EscharEx demonstrated a favourable benefit to risk profile.

    Original languageEnglish
    Pages (from-to)899-907
    Number of pages9
    JournalWound Repair and Regeneration
    Issue number6
    StatePublished - 1 Nov 2021


    • bromelain
    • chronic wounds
    • debridement
    • enzymatic

    ASJC Scopus subject areas

    • Surgery
    • Dermatology


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