Therapeutic effects and safety of oral Chinese patent medicine for COVID-19: A rapid systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Introduction: Chinese patent medicine (CPM) is an indispensable part of traditional Chinese medicine. Coronavirus Disease 2019 (COVID-19) manifests is an acute respiratory infectious disease. This systematic review aimed to evaluate the therapeutic effects and safety of oral CPM for COVID-19. Methods: We included randomized controlled trials (RCTs) that tested oral CPM for the treatment of COVID-19 identified from publications in CNKI, Wanfang, VIP, Web of Science, SinoMed, PubMed, Embase, BioRxiv, MedRxiv and arXiv before November 2nd, 2020. The risk of bias for each trial was assessed using the Cochrane Risk of Bias Tool 2.0. RevMan 5.4 software was used for data analyses. The certainty of the evidence was assessed using the online GRADEpro tool. Results: Seven RCTs including 1079 participants were identified. The overall bias was assessed as “some concerns” for all included trials. Oral CPM investigated were Lianhua Qingwen capsule/granules (连花清瘟胶囊/颗粒, LHQW), Jinhua Qinggan granules (金花清感颗粒, JHQG), Huoxiang Zhengqidripping pills (藿香正气滴丸, HXZQ), Toujie Quwen granules (透解祛瘟颗粒, TJQW) and Lianhua Qingke granules (连花清咳颗粒, LHQK). Compared with conventional western therapy alone for people with COVID-19 regarding the main outcomes, the results showed that oral CPM combined with conventional western therapy improved cure rate (RR = 1.20, 95% CI 1.04 to 1.38, involving LHQW and TJQW), reduced aggravation rate (RR = 0.50, 95% CI 0.29 to 0.85, involving LHQW, JHQG, LHQK and TJQW);with regard to additional outcomes, the results showed that add-on oral CPM shortened the duration of fever, cough and fatigue, improved the recovery rate of cough and fatigue, and increased the improvement and recovery rate of chest CT manifestations. There were some differences in therapeutic effects among various CPMs for the same COVID-19 outcome. The use of TJQW and LHQG appeared not to increase the risk of adverse events, but JHQG may cause mild diarrhea. Conclusions: Low-certainty or very low-certainty evidence demonstrated that oral CPM may have add-on potential therapeutic effects for patients with non-serious COVID-19. There are some differences in therapeutic effects between different oral CPMs for the same outcome of COVID-19. The use of TJQW and LHQG probably does not increase the risk of adverse events, but JHQG may cause mild diarrhea in patients. The conclusion of this review needs to be further confirmed by well-designed clinical trials with adequate sample sizes. Keywords Coronavirus Disease 2019;COVID-19;Chinese patent medicine;Chinese herbal medicine;Systematic review;Meta-analysis: