Juvista® (Avotermin)

Scars after surgery or trauma can cause a significant degree of psychosocial distress for people. For centuries, surgeons have been searching for methods of reducing scars and optimizing healing, to reduce these effects. To date, we know that several technique related factors as well as post surgical factors can effect the quality of the final scar. A new drug called Avotermin (trade name Juvista®) is based on the transforming growth factor (TGF)-β family of cytokines. These growth factors play a critical role in the final appearance of scars, and this represents one of the first drugs based on growth factors that may make a real difference in scars.

Renovo is a biopharmaceutical product company involved in in the discovery and development of drugs to reduce scarring. I have no relationship with the company whatsoever (I have nothing to disclose).

The July edition of the Plastic Surgery Journal (the main journal for plastic surgery in the North America) published the results of a study (1) performed to assess the efficacy of intradermal avotermin (TGF-β3) for the improvement scars following revisional surgery. They tested the drug in 60 patients, using intradermal injections of the drug immediately after the surgery and again at 24 hours. They used a double blind design study where neither the investigator or the interpreter of the results knew which patients were getting the real drug vs a placebo. There was significant improvement in the appearance of the scars in the avotermin treated group. Further, scar profilometry (think of this as a cast taken of the scar) showed significant reduction of the total scar surface area, compared to the placebo group. Microscopic assessment of the scars on biopsy showed that the collagen in the avotermin treated scars more closely resembled normal skin! That is pretty amazing! The final conclusion is that it seems to really work! This is a good example of Level I evidence in Plastic Surgery (that is the best evidence that there is).

What does that mean for consumers? This means that we can expect the drug to finally make its way to market within the next 2 or 3 years. There is no word yet on the price or availability of this drug.

But, before getting too excited about this, I want to inform you that the phase III clinical trials that ended in Europe in Feb. 2011 had disappointing results, since the drug failed to significantly improve the scars in a group of 350 patients tested. Photographs of the scars one year later were assessed and the independent panel of experts, using the Global Scar Comparison Scale, as well as the patients themselves assessed the scars and concluded that the results were not significant for either dose of the medication. So there are still things to be worked out before this drug comes to market, but overall, this seems to be a promising drug to all those people out there suffering with bad scars.

References:
1. So,Karen MB et al Avotermin for Scar Improvement following Scar Revision Surgery: A Randomized, Double-Blind, Within-Patient, Placebo-Controlled, Phase II Clinical Trial . Plastic & Reconstructive Surgery: July 2011 – Volume 128 – Issue 1 – pp 163-172