Vitamin D analogs combined with different types of phototherapy in the treatment of vitiligo: A systematic review of randomized trials and within-patient studies.

OBJECTIVES: This systematic review was to assess the effects of phototherapies (psoralen plus ultraviolet A [PUVA], narrowband ultraviolet B [NBUVB], or 308 nm excimer laser [EL]) in combination with vitamin D analogs compared with phototherapy alone on vitiligo. METHODS: Four databases were searched up to 18 October 2021 for relevant studies. The primary outcome was the proportion of response to treatment (≥50% repigmentation) after treatment. Secondary outcomes included excellent response, treatment failure, and safety. The risk ratio (RR) was used as the estimate measure in meta-analyses. RESULTS: Fourteen studies (n = 642) were included. The meta-analyses showed that the combination of either calcipotriol or tacalcitol and NBUVB was superior to NBUVB monotherapy for vitiligo in the proportion of response to treatment (RR 1.67, 95% CI 1.21-2.31), treatment failure (RR 0.43, 95% CI 0.22-0.85), and excellent response (RR 7.48, 95% CI 1.09-51.13). The tacalcitol was more effective than calcipotriol in increasing the rate of response to treatment when combined with NBUVB (RR 2.25 versus 1.24, interaction p = 0.002). The results did not support better efficacy with the combination of PUVA or EL with vitamin D analogs over phototherapy alone in all outcomes. Adverse events were minor and transient. CONCLUSIONS: The current evidence suggests that the additional use of topical calcipotriol or tacalcitol to NB-UVB may increase the treatment effect of vitiligo, and the effect of tacalcitol is greater than that of calcipotriol. None of the vitamin D analogs were found to enhance the efficacy of PUVA or EL for vitiligo.

Community-based heat-sensitive moxibustion for primary hypertension: study protocol for a randomized controlled trial with patient-preference arms.

BACKGROUND: Low- and middle-income countries have a high prevalence of primary hypertension, but its treatment and control are often low. Heat-sensitive moxibustion (HSM), an innovative acupoint stimulation technique, may be effective for treating hypertension and thus used appropriately in primary healthcare. The objective of this study is to investigate whether HSM is effective and safe for the treatment of primary hypertension in the community. METHODS: This study is a multicenter, pragmatic, randomized controlled trial (RCT) with patient-preference arms. Four hundred patients with primary hypertension from seven communities will be enrolled. Initially, the communities will be randomly assigned into two study clusters, one using compulsory randomization and the other allowing treatment selection by patient preferences. Then, patients in the compulsory randomization cluster will be randomized to receive HSM plus their original antihypertensive regimen (HSM group) or only their original antihypertensive regimen (control group) for 6 months. Patients in the patient preference cluster may choose to receive HSM or control if they have a preference; otherwise, patients will be randomly assigned. The primary outcome is the change in systolic blood pressure from baseline; secondary outcomes include change in diastolic blood pressure, dosage of antihypertensive drugs, quality of life (QoL), severity of hypertensive symptoms, and incidence of cardiovascular events. Patient compliance with the HSM regimen, the cost-effectiveness ratio, and safety outcomes will also be evaluated. Outcome data will be collected at 6 monthly visits. DISCUSSION: This trial will provide important evidence regarding HSM as a technique for primary hypertension in primary healthcare settings. Given the randomization with patient preferences considered, the trial will also allow analyzing patient-preference effects and the comparison of randomized and nonrandomized samples, to improve the robustness and extrapolation of study conclusions. TRIAL REGISTRATION: ClinicalTrials.gov NCT04788563 . Registered on March 9, 2021.

Moxibustion for alleviating chemotherapy-induced gastrointestinal adverse effects: A systematic review of randomized controlled trials.

OBJECTIVE: This systematic review aims to assess whether moxibustion is effective and safe for gastrointestinal adverse effects, a common and thorny issue arising from chemotherapy. METHODS: Seven electronic databases were searched up to August 28, 2021, to identify randomized controlled trials (RCTs) comparing moxibustion versus non-moxibustion treatments for various gastrointestinal adverse effects after chemotherapy. The Karnofsky performance status (KPS) and quality of life scores and the incidence of moxibustion-related adverse events were also investigated. Effects in meta-analyses were measured by risk ratios (RRs) or mean differences (MDs). RESULTS: Thirty-two RCTs (n = 2990) were included. Compared to the controls, moxibustion significantly reduced the incidences of nausea/vomiting (RR 0.70, 95% CI 0.61-0.79), severe nausea/vomiting (RR 0.39, 95% CI 0.29-0.51), diarrhoea (RR 0.56, 95% CI 0.38-0.82), constipation (RR 0.59, 95% CI 0.44-0.78), and abdominal distension (RR 0.60, 95% CI 0.46-0.78). The KPS (MD 7.53, 95% CI 3.42-11.64) and quality of life (MD 8.88, 95% CI 0.96-16.80) scores were also significantly improved after moxibustion. The results did not support a benefit of moxibustion on inappetence (RR 0.69, 95% CI 0.40-1.22) or abdominal pain (RR 0.60, 95% CI 0.28-1.30). All adverse events related to moxibustion were mild. CONCLUSIONS: Moderate-to very-low-quality evidence suggests that moxibustion may be safely used as an adjuvant treatment after chemotherapy to reduce the incidences of nausea and vomiting, diarrhoea, constipation, and abdominal distension and improve the performance status and quality of life in patients with malignant tumours. Its effects on abdominal pain and inappetence are uncertain.

Moxibustion as an Adjuvant Therapy for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of 23 Randomized Controlled Trials.

OBJECTIVE: This systematic review aims to investigate the efficacy and safety of moxibustion for chronic kidney disease (CKD). METHODS: Nine databases were searched to identify relevant evidence up to March 8, 2020. Randomized controlled trials (RCTs) that tested moxibustion + basic treatments versus basic treatments alone for patients with CKD and reported, at least, one of the outcomes of interest were included. In the meta-analyses, the mean differences (MDs) and 95% confidence intervals (CIs) were used to measure the effect size. RESULTS: Twenty-three RCTs (n = 1571) with a moderate to high risk of bias were included. The pooled estimates showed that compared with the controls, patients after moxibustion had a significant reduction in serum creatinine (MD -17.34 µmol/L, 95% CI -28.44 to -6.23; I 2 = 87%), 24-hour urine protein excretion (MD -0.75 g/h, 95% CI -1.07 to -0.42; I 2 = 84%), and blood urea nitrogen (MD -0.63 mmol/L, 95% CI -1.09 to -0.18; I 2 = 37%) and a significant improvement in the quality of life (MD 10.18, 95% CI 3.67 to 16.69; I 2 = 57%). Moxibustion did not show a significant effect on the estimated glomerular filtration rate (eGFR), creatinine clearance, or hemoglobin. The subgroup analyses showed that a longer course of moxibustion (>8 weeks) and indirect moxibustion had a greater effect on reducing serum creatinine. The effect of moxibustion on blood urea nitrogen changed to be nonsignificant after excluding RCTs with a high risk of bias (MD -0.96 mmol/L, 95% CI -2.96 to 1.03). Only one adverse event of burn was reported. CONCLUSIONS: This systematic review suggests that, as an adjuvant therapy, moxibustion may improve serum creatinine, urinary protein excretion, blood urea nitrogen, and quality of life in patients with CKD. Moxibustion may not have effects on eGFR, creatinine clearance, or hemoglobin. The quality of evidence is weakened by the limitations of risk of bias, heterogeneity, and imprecision.