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Anacaulase\u2010bcdb is a standardised pineapple stem\u2010derived proteolytic biologic approved for enzymatic eschar removal in eligible adult and paediatric thermal burns. This Drug Evaluation reviews the product's biological origin, composition, mechanism of action, regulatory status, administration, clinical efficacy, safety and place in therapy. A targeted review of peer\u2010reviewed and regulatory evidence was undertaken, prioritising the phase 3 DETECT trial, the randomised paediatric CIDS trial, systematic reviews, consensus guidance, prescribing information, and postmarketing studies. Anacaulase\u2010bcdb provides rapid eschar removal, reduces surgical excision and debridement\u2010related blood loss, and preserves subsequent options for conservative healing or grafting. Procedural pain, hypersensitivity, strict eligibility criteria, and specialist\u2010team requirements remain important limitations. Anacaulase\u2010bcdb is a clinically meaningful, tissue\u2010sparing adjunct rather than a replacement for burn surgery. Its greatest value is likely in eligible deep partial\u2010thickness and selected full\u2010thickness thermal burns treated within protocolized burn\u2010center pathways. Future adoption will depend on comparative effectiveness, cost\u2010effectiveness, real\u2010world safety, optimal patient selection and evidence that reduced operative burden translates into improved clinical and health\u2010system outcomes.<\/jats:p>","DOI":"10.1111\/wrr.70212","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:33:38Z","timestamp":1788780818000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anacaulase\u2010Bcdb for Enzymatic Eschar Removal in Adult and Paediatric Thermal Burns: Clinical Evidence, Safety, and Therapeutic Positioning"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0696-3057","authenticated-orcid":false,"given":"Sajid","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Horticulture and Life Science Yeungnam University  Gyeongsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7859-6510","authenticated-orcid":false,"given":"Muhammad Tahir","family":"Naseem","sequence":"additional","affiliation":[{"name":"Department of Electronic Engineering Yeungnam University  Gyeongsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6864-2366","authenticated-orcid":false,"given":"Wajid","family":"Zaman","sequence":"additional","affiliation":[{"name":"Department of Life Sciences Yeungnam University  Gyeongsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"World Health Organization \u201cBurns\u201d(2023)."},{"issue":"1","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41572-020-0145-5","article-title":"Burn Injury","volume":"6","author":"Jeschke M. 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