About NexoBrid®

NexoBrid may provide an alternative option to surgical excision that selectively and effectively removes eschar without compromising viable tissue.1–4

Current practices can make assessing burn depth challenging and may often result in the removal of too little eschar or too much viable tissue5

Surgical eschar removal5

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Surgical eschar removal can make assessing burn depth challenging

Surgical eschar removal may result in the removal of too little eschar or too much viable tissue vs the efficacy and selectivity of NexoBrid

and often results in the removal of too little eschar

Surgical eschar removal may result in the removal of too little eschar or too much viable tissue vs the efficacy and selectivity of NexoBrid

or too much viable tissue

Surgical eschar removal may result in the removal of too little eschar or too much viable tissue vs the efficacy and selectivity of NexoBrid

See NexoBrid Eschar Removal 

NexoBrid1–3

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NexoBrid selectively and efffectively removes eschar

Surgical eschar removal may result in the removal of too little eschar or too much viable tissue vs the efficacy and selectivity of NexoBrid

within in a 4-hour application period
(remove NexoBrid after 4 hours)

Surgical eschar removal may result in the removal of too little eschar or too much viable tissue vs the efficacy and selectivity of NexoBrid

without compromising viable tissue

Surgical eschar removal may result in the removal of too little eschar or too much viable tissue vs the efficacy and selectivity of NexoBrid

See Surgical Eschar Removal 

How NexoBrid Works

The mixture of enzymes in NexoBrid dissolves burn wound eschar. The specific components responsible for this effect have not been identified.1

See How NexoBrid Works
See How NexoBrid Works: Watch the Product Video

NexoBrid may lead to more precise wound depth determination2,3

The post-NexoBrid wound bed may reveal a shiny, healthy white dermis with pinpoint bleeding, similar to the appearance of a freshly harvested donor site.6

  • Burns originally deemed as “mixed” or “deep” may be reassessed as only superficial or partial thickness with viable dermal layers capable of re-epithelialization7
  • The distribution of any full thickness defects within the burn may be clearly diagnosed, as well as the other levels of injury with the exposure of underlying structures3,8

Before NexoBrid

Results before NexoBrid

Post Burn Day 2: Wound appearance evaluated as deep dermal and full thickness by treating surgeon.

After NexoBrid

Results after NexoBrid

Post Burn Day 3: After eschar removal with NexoBrid, shiny white dermis was revealed with superficial, deep dermal and full thickness components.

Images are from a real NexoBrid patient. Individual results may vary.

Selective eschar removal with NexoBrid may reveal a clear view of the extent of the original injury.3,8

  • Optimal wound management begins with accurate determination of wound depth9,10
  • After NexoBrid, these assessments can be made according to the vascular patterns and colors which may coincide with relevant structures of the dermis and subcutaneous layer3,8
  • Timely, effective eschar removal and burn assessment are critical to starting patients on a path to healing11,12

Before NexoBrid

Results before NexoBrid

Post Burn Day 2: Wound appearance deemed indeterminate depth by treating surgeon.

After NexoBrid

Results after NexoBrid

Post Burn Day 3: After eschar removal with NexoBrid, various wound depths were revealed based on dermal bleeding patterns.

Images are from a real NexoBrid patient. Individual results may vary.

Product illustration

NexoBrid Lyophilized Powder and Gel Vehicle

NexoBrid is available as 5 g lyophilized powder (containing 4.85 g of anacaulase-bcdb) mixed in 50 g gel vehicle for treatment of up to 450 cm2 of burn area after mixing3

  • For topical use only

NexoBrid may be applied to up to 15% body surface area (BSA) in one application1

Nexobrid Dosing1 Unit Orders*
  • Up to 15% body surface area (BSA) in one application
  • A second application may be applied 24 hours later—total treatment area must not exceed 20% BSA
 6 units =
~15% BSA

Nexobrid Dosing1 Unit Orders*
  • Up to 15% BSA in one application
  • A second application is not recommended
 6 units =
~15% BSA

Nexobrid Dosing1 Unit Orders*
  • Up to 10% BSA in one application
  • A second application is not recommended
 4 units =
~10% BSA
Age NexoBrid Dosing1 Unit
Orders*
Adults
  • Up to 15% body surface area (BSA) in one application
  • A second application may be applied 24 hours later—total treatment area must not exceed 20% BSA
 6 units=
~15% BSA
Pediatric Patients
6–17 Years of Age
  • Up to 15% BSA in one application
  • A second application is not recommended
 6 units=
~15% BSA
Pediatric Patients
under 6 Years of Age
  • Up to 10% BSA in one application
  • A second application is not recommended
 4 units=
~10% BSA

*Please consider that adults and pediatric patients have different body proportions and this may affect how surface area is calculated across the body.

Please see Full Prescribing Information for guidance on preparation and application.

Use pain management as practiced for an extensive dressing change of burn wounds 15 minutes prior to and throughout all NexoBrid-related procedures.

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Clinical Efficacy

Review the Data 

How To Use NexoBrid tongue depressor icon

How to Use Nexobrid

Start here 

Important Safety Information

Indication

NEXOBRID® (anacaulase-bcdb) is indicated for eschar removal in adults and pediatric patients with deep partial thickness (DPT) and/or full thickness (FT) thermal burns.

Limitations of Use

The safety and effectiveness of NEXOBRID have not been established for treatment of:

  • Chemical or electrical burns
  • Burns on the face, perineum, or genitalia
  • Burns on the feet of patients with diabetes mellitus or on the feet of patients with occlusive vascular disease
  • Circumferential burns
  • Burns in patients with significant cardiopulmonary disease, including inhalation injury

NEXOBRID is not recommended for:

  • Wounds contaminated with radioactive and other hazardous substances to avoid unforeseeable reactions with the product and an increased risk of spreading the noxious substance
  • Treatment of burn wounds where medical devices (e.g., implants, pacemakers, shunts) or vital structures (e.g., large vessels) could become exposed during eschar removal

Important Safety Information

Contraindications

NEXOBRID is contraindicated in patients with: known hypersensitivity to anacaulase-bcdb, bromelain, pineapples, or to any other components; known hypersensitivity to papayas or papain because of the risk of cross-sensitivity.

Important Safety Information

Indication

NEXOBRID® (anacaulase-bcdb) is indicated for eschar removal in adults and pediatric patients with deep partial thickness (DPT) and/or full thickness (FT) thermal burns.

Limitations of Use

The safety and effectiveness of NEXOBRID have not been established for treatment of:

  • Chemical or electrical burns
  • Burns on the face, perineum, or genitalia
  • Burns on the feet of patients with diabetes mellitus or on the feet of patients with occlusive vascular disease
  • Circumferential burns
  • Burns in patients with significant cardiopulmonary disease, including inhalation injury

NEXOBRID is not recommended for:

  • Wounds contaminated with radioactive and other hazardous substances to avoid unforeseeable reactions with the product and an increased risk of spreading the noxious substance
  • Treatment of burn wounds where medical devices (e.g., implants, pacemakers, shunts) or vital structures (e.g., large vessels) could become exposed during eschar removal

Important Safety Information

Contraindications

NEXOBRID is contraindicated in patients with: known hypersensitivity to anacaulase-bcdb, bromelain, pineapples, or to any other components; known hypersensitivity to papayas or papain because of the risk of cross-sensitivity.

Warnings and Precautions

Hypersensitivity Reactions

Serious hypersensitivity reactions, including anaphylaxis, have been reported with postmarketing use of anacaulase-bcdb. If a hypersensitivity reaction occurs, remove NEXOBRID (if applicable) and initiate appropriate therapy.

Healthcare personnel should take appropriate precautions to avoid exposure when preparing and handling NEXOBRID (e.g., gloves, surgical masks, other protective coverings, as needed).

Coagulopathy

Avoid use of NEXOBRID in patients with uncontrolled disorders of coagulation. Use with caution in patients on anticoagulant therapy or other drugs affecting coagulation, and in patients with low platelet counts and increased risk of bleeding from other causes. Monitor patients for possible signs of coagulation abnormalities and signs of bleeding.

Adverse Reactions

The most common adverse reactions (>5%) in adults were pruritus, pyrexia, wound complication, anemia, vomiting and insomnia. The most common adverse reactions (>5%) in pediatric patients were pruritus, pyrexia and vomiting.

Use in Special Populations
Geriatric Use

Clinical studies of NEXOBRID did not include sufficient numbers of subjects 65 years of age and older to determine whether they respond differently from younger adult subjects.

To report negative side effects contact Vericel Corporation at 888-454-BURN (888-454-2876) or FDA at 1-800-FDA-1088 (1-800-332-1088) or www.fda.gov/medwatch.

Please see Full Prescribing Information.

References: 1. NexoBrid Prescribing Information. Cambridge, MA. Vericel Corporation; 2024. 2. Krieger Y, Bogdanov-Berezovsky A, Gurfinkel R, et al. Efficacy of enzymatic debridement of deeply burned hands. Burns. 2012;38:108-112. 3. Palao R, Aguilera-Saez J, Collado JM, et al. Use of a selective enzymatic debridement agent (Nexobrid) for wound management: Learning curve. World J Dermatol. 2017;2;6(2):32-41. 4. Muhammad ZA, Ahmad T. Therapeutic uses of pineapple-extracted bromelain in surgical care. J Pak Med Assoc. 2017;67(1):121-125. 5. Gurfinkel R, Rosenberg L, Cohen S, et al. Histological assessment of tangentially excised burn eschars. Can J Plast Surg. 2010;18(3):e33-e36. PMID:21886431. 6. Rosenberg L, Lapid O, Bogdanov-Berezovsky A, et al. Safety and efficacy of a proteolytic enzyme for enzymatic burn debridement: a preliminary report. Burns. 2004;30:843-850. 7. Schulz A, Perbix W, Shoham Y, et al. Our initial learning curve in the enzymatic debridement of severely burned hands-management and pit falls of the initial treatments and our development of a post debridement wound treatment algorithm. Burns. 2017;42:326-336. 8. Korzeniowski T, Struzyna J, Torres K. Evaluation of bromelain-based enzymatic debridement combined with laser doppler imaging and healing of burn wounds. Med Sci Monit. 2022;28:e936713. 9. Singer A, Boyce S. Burn wound healing and tissue engineering. J Burn Care Res. 2017;38(3):e605-e613. doi: 10.1097/BCR.0000000000000538 10. Claes K, Decker I, Monstrey S, et al. Helpful hints in deciding what and when to operate after enzymatic debridement. Burns. 2022; doi.org/10.1016/j.burns.2022.01.004 11. Rosenberg L. Enzymatic Debridement of burn wounds. In: Herndon D. Total Burn Care. 4th ed. Elsevier Saunders, 2012:131-135. 12. Rowan MP, Cancio LC, Elster EA, et al. Burn wound healing and treatment: review and advancements. Critical Care. 2015. doi:10.1186/s13054-015-0961-2