Network Meta-analysis of 11 Chinese patent medicines in treatment of dilated cardiomyopathy / 中国中药杂志

Bayesian network Meta-analysis was performed to evaluate the efficacy and safety of different Chinese patent medicines in the treatment of dilated cardiomyopathy. The PubMed, EMbase, Cochrane Library, CNKI, Wanfang, and VIP were searched for the randomized controlled trial(RCT) from the inception to May 2023. The quality of the included RCT was evaluated by the Cochrane risk of bias assessment tool, and the data were analyzed by RStudio 3.6.3 calling the "gemtc" package. A total of 96 RCTs involving 8 452 patients, 11 Chinese patent medicines, and 8 outcome indicators were included. Network Meta-analysis is described as follows.(1)In terms of improving clinical total effective rate, except Yixinshu Capsules + conventional western medicine, Shexiang Baoxin Pills + conventional western medicine, and Xinshuai Mixture + conventional western medicine, the other Chinese patent medicines combined with conventional western medicine were superior to conventional western medicine alone, and Shenqi Yiqi Dropping Pills + conventional western medicine had the best effect.(2)In terms of improving left ventricular ejection fraction(LVEF), except Yixinshu Capsules + conventional western medicine and Shensong Yangxin Capsules + conventional western medicine, other Chinese patent medicines combined with conventional western medicine outperformed conventional western medicine alone, and Shexiang Baoxin Pills + conventional western medicine had the best effect.(3)In terms of reducing left ventricular end-diastolic dimension(LVEDD), Getong Tongluo Capsules + conventional western medicine, Xinshuai Mixture + conventional western medicine, Huangqi Mixture + conventional western medicine, Tongxinluo Capsules + conventional western medicine, Wenxin Granules + conventional western medicine, and Qili Qiangxin Capsules + conventional western medicine were better than conventional western medicine alone, and Wenxin Granules + conventional western medicine had the best effect.(4)There was no significant difference in reducing left ventricular end-systolic diameter(LVESD) between Chinese patent medicines combined with conventional western medicine and conventional western medicine alone.(5)In terms of improving 6-minute walking trail(6MWT), Yangxinshi Tablets + conventional western medicine, Yixinshu Capsules + conventional western medicine, Shenqi Yiqi Dropping Pills + conventional western medicine, Wenxin Granules + conventional western medicine, and Qili Qiangxin Capsules + conventional western medicine were superior to conventional western medicine alone, and Shenqi Yiqi Dropping Pills + conventional western medicine had the best effect.(6)In reducing brain natriuretic peptide(BNP), Xinshuai Mixture + conventional western medicine ourperformed conventional western medicine alone.(7)In reducing hypersensitive C-reactive protein(hs-CRP), Shenqi Yiqi Dropping Pills + conventional western medicine, Qili Qiangxin Capsules + conventional western medicine outperformed conventional western medicine alone, and Qili Qiangxin Capsules + conventional western medicine had the best effect.(8)In terms of safety, adverse reactions were reported in both groups. In conclusion, Chinese patent medicine combined with conventional western medicine were more effective in the treatment of dilated cardiomyopathy. The combinations relieve clinical symptoms and improve cardiac function indexes, and thus can be used according to the patients' conditions in clinical practice. However, limited by the quality and sample size of the included studies, the conclusion remains to be verified by multi-center, large-sample, and high-quality RCT in the future.

[Meta-analysis of Naoxintong Capsules combined with Western medicine in treatment of chronic heart failure].

The safety and efficacy of Naoxintong Capsules combined with Western medicine in treatment of chronic heart failure(CHF) were analyzed based on Meta-analysis system. Databases, such as CNKI, VIP, WanFang, PubMed, EMbase and Cochrane Library, were retrieved from the inception to 31 August, 2019, to collect literatures about the effect of Naoxintong Capsules in treating CHF. RevMan 5.3 software provided by Cochrane collaboration network was used for statistical processing of the extracted data. This study included 15 RCTs, involving 1 595 patients, including 802 cases in the treatment group and 787 cases in the control group. The quality of the literatures was generally low. Meta-analysis results showed that the clinical efficacy rate on patients can be significantly improved by adding Naoxintong Capsules to conventional Western medicine, so as to significantly increase chronic heart failure(RR=1.24, 95%CI[1.18, 1.31], P<0.000 01), ventricular ejection fraction(MD=3.96, 95%CI[2.64, 5.27], P<0.000 01), left ventricular short axis shortening rate(MD=4.17, 95%CI[2.25, 6.10], P<0.000 1), and stroke volume(MD=10.27, 95%CI[8.47, 12.08], P<0.000 01), and reduce type B natriuretic peptide(MD=-50.10, 95%CI[-68.42,-31.78], P<0.000 01), left ventricular end-diastolic diameter(MD=-5.69, 95%CI[-7.68,-3.69], P<0.000 01), left ventricular end-systolic diameter(MD=-4.05, 95%CI[-4.89,-3.21], P<0.000 01) and left ventricular end-systolic volume(MD=-6.67, 95%CI[-8.46,-4.88], P<0.000 01), with statistically significant differences. Naoxintong Capsules combined with Western medicine can improve the clinical efficacy on patients with chronic heart failure, and cardiac function indexes and B-type natriuretic peptide levels.