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. 2016 Jan 15;2016(1):CD011753.
doi: 10.1002/14651858.CD011753.pub2.

A 'test and treat' strategy for elevated wound protease activity for healing in venous leg ulcers

Gill Norman  1 , Maggie J Westby, Nikki Stubbs, Jo C Dumville, Nicky Cullum
Affiliations

A 'test and treat' strategy for elevated wound protease activity for healing in venous leg ulcers

Gill Norman et al. Cochrane Database Syst Rev. .

Abstract

Background: Venous leg ulcers are a common and recurring type of complex wound. They can be painful, malodorous, prone to infection and slow to heal. Standard treatment includes compression therapy and a dressing. The use of protease-modulating treatments for venous leg ulcers is increasing. These treatments are based on some evidence that a proportion of slow to heal ulcers have elevated protease activity in the wound. Point-of-care tests which aim to detect elevated protease activity are now available. A 'test and treat' strategy involves testing for elevated proteases and then using protease-modulating treatments in ulcers which show elevated protease levels.

Objectives: To determine the effects on venous leg ulcer healing of a 'test and treat' strategy involving detection of high levels of wound protease activity and treatment with protease-modulating therapies, compared with alternative treatment strategies such as using the same treatment for all participants or using a different method of treatment selection.

Search methods: We searched the following electronic databases to identify reports of relevant randomised clinical trials: The Cochrane Wounds Group Specialised Register (January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) Issue 12, 2015); Ovid MEDLINE (1946 to January 2016); Ovid MEDLINE (In-Process & Other Non-Indexed Citations January 2016); Ovid EMBASE (1974 to January 2016); EBSCO CINAHL (1937 to January 2016). We also searched three clinical trials registers, reference lists and the websites of regulatory agencies. There were no restrictions with respect to language, date of publication or study setting.

Selection criteria: Published or unpublished RCTs which assessed a test and treat strategy for elevated protease activity in venous leg ulcers in adults compared with an alternative treatment strategy. The test and treat strategy needed to be the only systematic difference between the groups.

Data collection and analysis: Two review authors independently performed study selection; we planned that two authors would also assess risk of bias and extract data.

Main results: We did not identify any studies which met the inclusion criteria for this review. We identified one ongoing study; it was unclear whether this would be eligible for inclusion.

Authors' conclusions: Currently there is no randomised evidence on the impact of a test and treat policy for protease levels on outcomes in people with venous leg ulcers.

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Conflict of interest statement

Nicky Cullum: none known.

Jo Dumville: none known.

Gill Norman: My employment at the University of Manchester is supported by a grant from National Institute for Health Research, UK (NIHR Cochrane Programme Grant 13/89/08‐High Priority Cochrane Reviews in Wound Prevention and Treatment).

Nikki Stubbs Funding from pharmaceutical companies supports training and education events in the service and payments have been received by the author for non product related educational sessions. These have been unrelated to the subject matter of the systematic review and have never been in support or in pursuit of the promotion of products.

Maggie Westby My current employment at the University of Manchester is funded by NIHR and focuses on high priority Cochrane reviews in the prevention and treatment of wounds. In my previous employment at the Royal College of Physicians, I worked on methods for test and treat reviews and conducted two reviews for NICE and KCE guidelines (no financial conflicts of interest).

Figures

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PRISMA Study flow diagram
See this image and copyright information in PMC

Update of

References

References to studies excluded from this review

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