Comparative Effectiveness of Clostridial Collagenase Ointment to Medicinal Honey for Treatment of Pressure Ulcers in the Hospital Outpatient Department Setting

Adrienne Gilligan, PhD1, Curtis Waycaster, PhD2, Rich Bizier, BS1, Bong Chul Chu, PhD1, Marissa Carter, Ph.D., MA3 and Caroline Fife, MD, CWS4, (1)Truven Health Analytics, Ann Arbor, MI, (2)Market Access, Smith & Nephew, Fort Worth, TX, (3)Strategic Solutions, Inc., Strategic Solutions Inc, Cody, WY, (4)Geriatrics, Baylor College of Medicine, Houston, TX
Objective:Assess the effectiveness of enzymatic debridement with clostridial collagenase ointment (CCO) relative to autolytic debridement with medicinal honey (MH) in the hospital outpatient department (HOPD) setting for the treatment of pressure ulcers (PU).

Methods:Retrospective de-identified electronic medical records from 2007-2013 were extracted from the U.S. Wound Registry (USWR). Propensity score matching method was used to adjust for selection bias and to test for treatment effect between PU treated with CCO versus MH. Outcomes of interest included 100% granulation of the wounds at 1-year, epithelialization of the wounds at 1-year and 2-years and measures of resource utilization.

Results:A total of 517 CCO PU were matched to a corresponding 517 MH PU (mean age 66.2 vs. 63.6 years). The majority of PU in the CCO and MH cohorts were stage III (56% vs. 55%) and located on the sacrum/buttock (32% vs. 37%). Compared to MH, CCO patients had significantly fewer HOPD visits (9.1 vs. 12.6), fewer selective sharp debridements (2.7 vs. 4.4), and less likely to receive negative pressure wound therapy (29% vs. 38%), all p<0.01. PU treated with CCO were 38% more likely to achieve 100% granulation compared to MH PU at 1-year, p=0.018. The average number of days to 100% granulation was significantly lower for PU treated with CCO (255 days vs. 282 days, p<0.001).  CCO-treated PU were 47% and 39% more likely to epithelialize at 1-year and 2-years compared to MH treated PU, p<0.01 for both values. The average number of days to epithelialization was significantly lower for CCO treated PU at 1-year and 2-years (288 days vs. 308 days and 549 days vs. 595 days, p<0.01 for both values).

Conclusion:PU treated with CCO demonstrated significant clinically meaningful advantages over MH in all stages of PU in regards to granulation tissue formation and subsequent epithelialization.