Bromelain-based debridement versus collagenase ointment debridement of venous leg ulcers: post hoc analysis of the ChronEx trial

BACKGROUND: A randomized controlled trial reported that bromelain-based enzymatic debridement (BBD) more effectively debrided and granulated venous leg ulcers (VLUs) compared with placebo (gel vehicle, hydrogel) and nonsurgical standard of care (including collagenase ointment [CO]). OBJECTIVE: To assess the efficacy of BBD vs CO-based enzymatic debridement in VLUs during the ChronEx trial. MATERIALS AND METHODS: The Wilcoxon exact test was used to compare the proportion of wounds in each group that achieved complete debridement and granulation at 2 weeks. Kaplan-Meier analysis was used to compare median times to complete debridement and granulation between groups. RESULTS: Forty-six patients with 46 wounds were treated with BBD, and 8 were treated with CO. Twenty-nine wounds treated with BBD (63%; 95% CI, 48-77) were completely debrided within 2 weeks compared with none treated with CO (P = .001). Twenty-three wounds treated with BBD (50%; 95% CI, 35-65) achieved complete granulation by 2 weeks compared with none with CO (P = .015). The estimated median time to complete debridement and complete granulation, respectively, in the BBD group vs the CO group, respectively, were 9 days vs not achieved (P = .023), and 11 days vs not achieved (P = .014). The groups had comparable safety and pain profiles. CONCLUSION: BBD appears to be more effective and faster than CO in achieving complete debridement and granulation of VLUs as part of wound bed preparation.