Next-generation Enzymatic Therapeutic for Non-Surgical Tissue Repair

Next-Generation Enzymatic Therapy for Wound Care

  • Indication:Debridement of chronic/hard-to-heal wounds
  • Classification:Biological drug
  • Target audience:Patients is any wound healing setting
  • Development status:Phase 3 initiation expected in 2H 2024

EscharEx is a bioactive therapy for debridement of chronic and other hard-to-heal wounds is a product candidate in advanced stages of development. EscharEx, a concentrate of proteolytic enzymes enriched in bromelain, is an easy to use product candidate, for topical daily applications, which designed for the outpatient setting in accordance with the current treatment workflow and reimbursement programs. EscharEx has demonstrated in three phase 2 studies safety and efficacy in the debridement of various chronic and other hard-to-heal wounds, with only a few daily applications.

As a rapid and effective debridement agent, EscharEx is complementary to the large number of existing advanced wound healing therapies, which require a clean wound bed in order to heal the wound.

EscharEx is a topical bioactive agent being developed for debridement of chronic and other hard-to-heal wounds, in order to fulfill an unmet medical need for a non-surgical rapid and effective debridement mean. Each year approximately 2 million patients with Venus Leg Ulcers (VLUs) and Diabetic Foot Ulcers (DFUs) are eligible for debridement in the U.S. alone.

How to Use

Topical Bioactive Debridement Agent

EscharEx is intended to be topically-applied over the wound bed for several 24-hours applications, until the necrotic tissue is removed and the wound is debrided.

The mechanism of action of EscharEx is mediated by the proteolytic enzymes that cleave and remove the necrotic tissue and prepare the wound bed for healing.

EscharEx is:

• Designed to debride chronic wounds in 4-8 daily applications
• Designed to promote granulation tissue
• Designed to reduce biofilm & bacteria
• In-line with current treatment workflows and reimbursement landscape
• Easy to use daily topical application designed for outpatient setting


Wound Cleansing


Topical Application


Wound Dressing


Dressing Change & Re-Application

Scientific Evidence

Phase 2 Studies

In three Phase 2 studies that we conducted, EscharEx was well-tolerated and demonstrated safety and efficacy in the debridement of chronic and other hard-to-heal wounds, in a few daily applications.

The objectives of our second US phase 2 trial were to assess the efficacy and safety of EscharEx in debriding chronic wounds, and to further analyze these effects in different etiologies to guide the design of future pivotal studies.

The study met its primary endpoint with statistical significance. Patients treated with EscharEx demonstrated a higher incidence of complete debridement compared with patients treated with the hydrogel vehicle, and debridement was achieved earlier.

Positive results were received from the U.S. prospective, open-label, single-arm, Phase 2 pharmacology clinical study of EscharEx® for the debridement of lower leg ulcers.

The study was designed to evaluate the clinical performance, safety and pharmacology effect of EscharEx in debridement of venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). Seventy percent of patients achieved complete debridement during the course of treatment within up to 8 applications. On average, complete debridement was achieved after 3.9 applications of EscharEx. Additionally, an average reduction of 35% in wound size was achieved by the end of the 2-week follow-up period. In all patients that were positive for biofilm at baseline, the biofilm was reduced substantially to single individual microorganisms or completely removed by the end of treatment. Seven patients had positive red fluorescence (indicative of bacteria) at baseline and average red fluorescence was reduced from 1.69 cm2 pre-treatment to 0.60 cm2 post treatment. Biomarker analysis from wound fluid is on-going and safety data shows that EscharEx is safe and well-tolerated.

The safety profile was comparable to hydrogel vehicle and no deleterious effect on wound healing was observed.

A recent Phase 2 clinical study of EscharEx® for the debridement of venous leg ulcers (VLUs) also received positive results. This study also met its primary endpoint, its key secondary endpoints with high degree of statistical significance, as well as its wound closure safety measurements demonstrating that patients treated with EscharEx had a statistically significant higher incidence of complete debridement during the 14-day measurement period within up to 8 applications compared to gel vehicle (EscharEx: 63% (29/46) vs. gel vehicle: 30% (13/43), p-value=0.004). EscharEx efficacy superiority remained statistically significant compared to gel vehicle after adjusting for pre-specified covariates ascribed to patient baseline characteristics, wound size, wound age and regions.

The study met key secondary and exploratory endpoints. Patients treated with EscharEx had a statistically significant higher incidence of complete debridement, during the same 14-day measurement period, compared to patients treated by non-surgical standard-of-care (“NSSOC”) (EscharEx: 63% (29/46) vs. NSSOC: 13% (4/30)) and the time to achieve complete debridement was significantly shorter. Estimated median time to complete debridement, was 9 days for patients treated with EscharEx and 59 days for patients treated with NSSOC (p-value=0.016). On average, complete debridement was achieved after 3.6 applications of EscharEx compared to 12.8 applications with NSSOC. Patients treated with EscharEx demonstrated significantly higher incidence of at least 75% granulation tissue at the end of the treatment period compared to gel vehicle (p-value <0.0001). Favorable trends were observed in wound area reduction and reduction of pain compared to gel vehicle.

In addition, the study showed that EscharEx was safe and well tolerated, and the overall safety was comparable between the arms as assessed by the data safety monitoring board. Importantly, there were no observed deleterious effects on wound closure and no material differences in reported adverse events. Estimated time to complete wound closure was 64 days for patients treated with EscharEx compared to 78 days for patients treated with NSSOC.

EscharEx also received positive results in a head-to-head comparison with SANTYL®
within the ChronEx Phase II Randomized Controlled Study. Results demonstrated superiority of EscharEx® over SANTYL® in wound debridement, promotion of granulation tissue, and time to wound closure in patients with chronic venous leg ulcers (VLU) SANTYL is currently the market-leading enzymatic debridement product, with more than $360 million in estimated annual sales in the United States.
Results from the previously disclosed Phase II study (ChronEx) which evaluated the safety and efficacy of EscharEx, demonstrated the superiority of EscahrEx vs. a gel vehicle (placebo) and non-surgical standard of care (NSSOC), in achieving complete debridement of non-viable tissue and promotion of granulation tissue (healthy, highly vascularized tissue). The secondary analyses assessed the incidence and time to
complete debridement, complete granulation, and wound closure in patients treated with EscharEx (n=46) compared to a sub-group of patients who were treated with SANTYL (n=8).

The Company’s global Phase III clinical study for EscharEx is expected to begin in the latter half of 2024.


Phase 2 Study Successful Results


Clinical Sites


Number of Patients


EscharEx Phase II- Safety & Efficacy are Well Demonstrated


EscharEx vs. Non- Surgical SOC


EscharEx vs. Non- Surgical SOC


Selected Publications:

An Open-Label, Proof-of-Concept Study Assessing the E!ects of Bromelain-Based Enzymatic Debridement on Biofilm and Microbial Loads in Patients With Venous Leg Ulcers and Diabetic Foot Ulcers

Robert J. Snyder, Adam J. Singer, Cyaandi R. Dove, Stephen Heisler, Howard Petusevsky, Garth James, Elinor deLancey Pulcini, Aya Ben Yaakov, Lior Rosenberg, Edward Grant, Yaron Shoham

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