(CR-060) Long-Term Scar Outcomes After Enzymatic Debridement with NexoBrid vs. Standard of Care: A Post-Hoc Analysis of Pooled DETECT and CIDS Data

Jeremy Goverman, Professor; Asi Haviv, DMD; Yaron Shoam, Professor

Introduction: Selective debridement is a critical component of wound bed preparation across acute and chronic wounds, influencing downstream healing quality and long-term scar outcomes. Clinical trials have demonstrated that bromelain-based enzymatic debridement (NexoBrid®) is non-inferior to standard of care (SOC), which primarily consisted of surgical debridement by tangential excision, with respect to long-term scar outcomes in burn wounds. This pooled analysis evaluates 12-month scar outcomes following NexoBrid treatment in adult and pediatric patients with deep burns, providing insights relevant to broader wound care settings where preservation of viable tissue is essential.

Methods: Pooled data from two completed phase III randomized controlled trials, DETECT in adults and CIDS in pediatrics, were analyzed. In both studies, SOC consisted mainly of surgical debridement using tangential excision, with subsequent wound management according to local practice. Scar outcomes were assessed at 12 months (12M) post-injury using total and domain scores of the Modified Vancouver Scar Scale (MVSS) and the Patient and Observer Scar Assessment Scale (POSAS), evaluated by target wound. Deep partial-thickness (DPT) wounds were further analyzed according to autograft use, yes or no. Between-group comparisons were performed using one-way ANOVA.

Results: A total of 300 wounds were evaluated at 12M, with 160 in the NexoBrid group and 140 in the SOC group. This included 146 non-autografted DPT wounds, 82 treated with NexoBrid and 64 with SOC, and 50 autografted wounds, approximately 25 percent of DPT wounds. Overall, NexoBrid demonstrated significantly improved scar outcomes versus SOC, with MVSS scores of 3.9 versus 4.6 (p=0.030) and POSAS scores of 33.9 versus 39.9 (p=0.009). The treatment effect was primarily driven by non-grafted DPT wounds, with superior outcomes observed for NexoBrid compared with SOC (MVSS 3.3 vs. 4.3, p=0.033; POSAS 27.9 vs. 36.7, p=0.030). Domain-level analyses showed reduced hypertrophic scarring and improvements in pigmentation, pliability, and surface regularity following NexoBrid treatment.

Discussion: Bromelain-based enzymatic debridement with NexoBrid is associated with superior long-term scar outcomes compared with SOC at 12 months, particularly in non-grafted DPT wounds. These findings underscore the importance of selective debridement in preserving viable tissue and supporting re-epithelialization and regeneration. These principles are highly relevant to both acute burn management, as demonstrated by NexoBrid, and chronic wound care, where bromelain-based enzymatic debridement (EscharEx) is in late-stage clinical development. Collectively, these data highlight that early wound bed optimization may influence long-term functional and aesthetic outcomes.