My colleagues and I read with great interest the recent randomized clinical trial by Parsa and colleagues, which demonstrated the superior efficacy of autologous platelet-rich plasma (PRP) over standard care in promoting wound area reduction in diabetic foot ulcers (DFUs) over a 9-week period 1. The study is commendable for its rigorous double-blind, randomized design and its use of a clinically meaningful endpoint (> 50% wound area reduction) aligned with IWGDF standards. The findings add to a growing body of evidence supporting PRP as a promising adjunctive therapy. However, as clinicians deeply involved in the longitudinal management of patients with chronic diabetic complications, we wish to highlight a critical perspective that extends beyond the study's primary timeframe 1. DFUs are not merely acute wounds but represent a chronic, recalcitrant condition with a high propensity for recurrence. Therefore, while demonstrating accelerated short-term healing—as this study successfully does—is a crucial first step, it constitutes only one part of the therapeutic value equation. For a therapy like PRP to be firmly integrated into standard care pathways, especially within resource-conscious public health systems, evidence addressing two additional dimensions is paramount: long-term durability of healing and comprehensive cost-effectiveness. Firstly, the absence of long-term follow-up data, as acknowledged by the authors, leaves a significant gap. The primary outcome of wound area reduction at 9 weeks does not inform us about the rate of ulcer recurrence, the long-term amputation risk, or the patient's quality of life and functional status over subsequent months or years. A therapy that accelerates initial closure but does not alter the underlying pathophysiology or the patient's risk profile for recurrence may have a limited impact on the overall disease burden. For instance, did the robust healing observed in the PRP group at 9 weeks translate into sustained closure at 6 or 12 months? Were there differences in re-ulceration rates between the groups? Patient-reported outcomes, such as pain reduction, mobility improvement, and health-related quality of life, are equally vital for assessing the true benefit of an intervention from the patient's perspective. Future studies building on this excellent work should prioritize these long-term, patient-centered endpoints 2. Secondly, the economic argument for PRP, though logically posited in the discussion, requires empirical validation through formal analysis. The authors rightly note that PRP's moderate upfront costs might be offset by long-term savings from reduced complications. This is a compelling hypothesis, but it remains a hypothesis within the context of this study. A full cost-effectiveness analysis would need to quantify not only the direct costs of PRP preparation and application but also the downstream economic impacts: reductions in the frequency of dressing changes, nursing visits, hospital admissions for infection, surgical debridements, and most significantly, amputations 3. The observation of no amputations in the PRP group is intriguing and underscores the potential for substantial cost savings and quality-of-life preservation. However, to convince healthcare policymakers and payers, robust data from larger trials incorporating detailed economic evaluations are essential. In light of these points, we propose that the logical and necessary next step is the design and execution of pragmatic, multicenter, randomized controlled trials with extended follow-up periods (e.g., 12−24 months). These trials should: Capture long-term clinical outcomes: Primary endpoints should include not only short-term healing but also ulcer recurrence-free survival, major adverse limb events (including amputation), and validated patient-reported outcome measures. Incorporate concurrent economic evaluation: Employ a within-trial cost-effectiveness analysis from a relevant healthcare system perspective, capturing all relevant resource use and health outcomes to calculate metrics such as the incremental cost-effectiveness ratio (ICER) 4. Explore heterogeneity of treatment effect: Larger sample sizes would allow for subgroup analyses to identify which patients (e.g., by ulcer severity, perfusion status, or microbiology) derive the greatest benefit from PRP, enabling more personalized and cost-effective application 5. The study by Parsa et al. provides a strong foundation and a clear signal of efficacy. By addressing the gaps in long-term effectiveness and economic value through the proposed research agenda, we can move from proving that PRP can heal ulcers faster to understanding whether it should be adopted as a standard, sustainable component of DFU management 1, 5. This would ultimately deliver more complete and actionable evidence for clinicians, patients, and health systems alike. Kong Qingfei conceptualized the letter, conducted the literature analysis, and drafted the manuscript. All colleagues (Xiao Wen) participated in a critical discussion of the ideas, reviewed the draft, and provided intellectual input leading to the final version. All authors approved the final manuscript for submission. We would like to express our gratitude to Dr. Yang Zhengqiang, the deputy director of the Endocrinology Department and General Medicine Department of Beijing Huairou Hospital. He has provided us with tremendous support and encouragement in the selection of journals and the reading of articles. He is extremely meticulous and rigorous. It is precisely because of his work that we believe it is feasible and worthwhile to engage in clinical research in addition to our clinical work. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.
Kong et al. (Fri,) studied this question.