Mei Wang1, Xin Guan2, Yuan Chi3, Nicola Robinson4, Jian-Ping Liu5. 1. Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China; School of Basic Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang, Liaoning, 110847, China. Electronic address: linhan616@126.com. 2. The Second Department of Respiratory Medicine, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi District, Shenyang, Liaoning, 110022, China. Electronic address: gx0621@126.com. 3. School of Basic Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang, Liaoning, 110847, China. Electronic address: chemcy@mail.dlut.edu.cn. 4. London South Bank University, 103 Borough Road, London, SE1 0AA, UK. Electronic address: nicky.robinson@lsbu.ac.uk. 5. Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China; School of Basic Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang, Liaoning, 110847, China. Electronic address: jianping_l@hotmail.com.
Abstract
INTRODUCTION: Chinese herbal medicine (CHM) has been increasingly used as an adjuvant treatment for multi-drug resistant tuberculosis (MDR-TB) in China. To inform clinical practice, we performed a systematic review on the beneficial effect and safety of CHM for MDR-TB. METHODS: We searched six electronic databases for randomised clinical trials (RCTs) of CHM for MDR-TB. We used RevMan 5.2 software for data analyses with effect estimates as risk ratio (RR) with 95% confidence interval (CI). RESULTS: 30 RCTs involving 3374 participants with MDR-TB were included. The methodological quality was generally poor in terms of risk of bias. Meta-analyses favoured CHM plus chemotherapy on sputum bacteriological conversion rate compared with chemotherapy alone after initiation of treatment (6th mos: RR 1.27, 95% CI 1.14 to 1.41, n = 12; 12th mos: RR 1.30, 95% CI 1.11 to 1.52, n = 6; 18th mos: RR 1.19, 95% CI 1.11 to 1.27, n = 9). Compared with chemotherapy alone, meta-analyses showed benefit from CHM plus chemotherapy on lung lesions resorption rate (6th mos: RR 1.10, 95% CI 0.91 to 1.32, n = 5; 12th mos: RR 1.26, 95% CI 1.10 to 1.45, n = 4; 18th mos: RR 1.19, 95% CI 1.08 to 1.32, n = 7) and cavity closure rate (12th mos: RR 1.48, 95% CI 1.06 to 2.07, n = 2; 18th mos: RR 1.26, 95% CI 1.04 to 1.53, n = 5), relapse rate (RR 0.28, 95% CI 0.16 to 0.50, n = 4), and abnormal liver function (RR 0.56, 95% CI 0.46 to 0.69, n = 14). No serious adverse effects were reported. CONCLUSIONS: CHM as an adjuvant to anti-TB chemotherapy may have beneficial effect for MDR-TB in terms of bacteriological and radiological outcomes, and is relatively safe. However, due to poor methodological reporting of the included trials, a confirmative conclusion needs to be supported by further robust clinical trials.
INTRODUCTION: Chinese herbal medicine (CHM) has been increasingly used as an adjuvant treatment for multi-drug resistant tuberculosis (MDR-TB) in China. To inform clinical practice, we performed a systematic review on the beneficial effect and safety of CHM for MDR-TB. METHODS: We searched six electronic databases for randomised clinical trials (RCTs) of CHM for MDR-TB. We used RevMan 5.2 software for data analyses with effect estimates as risk ratio (RR) with 95% confidence interval (CI). RESULTS: 30 RCTs involving 3374 participants with MDR-TB were included. The methodological quality was generally poor in terms of risk of bias. Meta-analyses favoured CHM plus chemotherapy on sputum bacteriological conversion rate compared with chemotherapy alone after initiation of treatment (6th mos: RR 1.27, 95% CI 1.14 to 1.41, n = 12; 12th mos: RR 1.30, 95% CI 1.11 to 1.52, n = 6; 18th mos: RR 1.19, 95% CI 1.11 to 1.27, n = 9). Compared with chemotherapy alone, meta-analyses showed benefit from CHM plus chemotherapy on lung lesions resorption rate (6th mos: RR 1.10, 95% CI 0.91 to 1.32, n = 5; 12th mos: RR 1.26, 95% CI 1.10 to 1.45, n = 4; 18th mos: RR 1.19, 95% CI 1.08 to 1.32, n = 7) and cavity closure rate (12th mos: RR 1.48, 95% CI 1.06 to 2.07, n = 2; 18th mos: RR 1.26, 95% CI 1.04 to 1.53, n = 5), relapse rate (RR 0.28, 95% CI 0.16 to 0.50, n = 4), and abnormal liver function (RR 0.56, 95% CI 0.46 to 0.69, n = 14). No serious adverse effects were reported. CONCLUSIONS:CHM as an adjuvant to anti-TB chemotherapy may have beneficial effect for MDR-TB in terms of bacteriological and radiological outcomes, and is relatively safe. However, due to poor methodological reporting of the included trials, a confirmative conclusion needs to be supported by further robust clinical trials.
Authors: Carole D Mitnick; Richard A White; Chunling Lu; Carly A Rodriguez; Jaime Bayona; Mercedes C Becerra; Marcos Burgos; Rosella Centis; Theodore Cohen; Helen Cox; Lia D'Ambrosio; Manfred Danilovitz; Dennis Falzon; Irina Y Gelmanova; Maria T Gler; Jennifer A Grinsdale; Timothy H Holtz; Salmaan Keshavjee; Vaira Leimane; Dick Menzies; Giovanni Battista Migliori; Meredith B Milstein; Sergey P Mishustin; Marcello Pagano; Maria I Quelapio; Karen Shean; Sonya S Shin; Arielle W Tolman; Martha L van der Walt; Armand Van Deun; Piret Viiklepp Journal: Eur Respir J Date: 2016-09-01 Impact factor: 16.671