Leonard Ho1, Claire Cw Zhong2, Charlene Hl Wong3, Justin Cy Wu4, Karina Kh Chan5, Irene Xy Wu6, Ting Hung Leung7, Vincent Ch Chung8. 1. School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Electronic address: leonard.ho@link.cuhk.edu.hk. 2. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Electronic address: chenwenzhong@link.cuhk.edu.hk. 3. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Electronic address: charlene.wong@link.cuhk.edu.hk. 4. Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Electronic address: justinwu@cuhk.edu.hk. 5. United Christian Nethersole Community Health Service - The Chinese University of Hong Kong Chinese Medicine Clinic Cum Training and Research Centre (Tai Po District), Hong Kong. Electronic address: karina.chan@ucn.org.hk. 6. Xiangya School of Public Health, Central South University, Hunan, China. Electronic address: irenexywu@csu.edu.cn. 7. School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Electronic address: leungthcmph@cuhk.edu.hk. 8. School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Electronic address: vchung@cuhk.edu.hk.
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Conventional treatments for functional dyspepsia (FD) are limited. Herbal medicine (HM) use is prevalent despite unclear comparative effectiveness among different formulae. AIM OF THE STUDY: This network meta-analysis (NMA) aimed to evaluate the comparative effectiveness of HM formulae for FD against placebo. MATERIALS AND METHODS: Seven international and Chinese databases were searched for randomised controlled trials (RCTs) on HM versus placebo. Risk of bias among RCTs was assessed using Cochrane Risk-of-Bias Tool 2. Data from RCTs were extracted for random-effect pairwise meta-analyses. NMAs were performed to evaluate the comparative effectiveness of HM formulae. GRADE partially contextualised framework was adopted to facilitate NMA result interpretation. RESULTS: Twelve different HM formulae were identified from fifteen RCTs of mediocre quality. At 8-week follow-up, pairwise meta-analyses indicated that HM was superior to placebo in alleviating global symptoms (pooled risk difference (RD): 0.20; 95% confidence interval (CI): 0.11-0.29), with effect size larger than the minimally clinically important difference of 0.20 RD. Sensitivity analysis showed no significant impact on results attributable to risk of bias. NMAs demonstrated that Xiao Yao Pill and Modified Ban Xia Xie Xin Decoction probably have a large beneficial effect on alleviating global symptoms (RD: 0.37; 95% CI: 0.03-0.99) and postprandial fullness (standardised mean difference: -0.93; 95% credible interval: -1.61 to -0.06), respectively. No serious adverse events were reported. CONCLUSIONS: Xiao Yao Pill and Modified Ban Xia Xie Xin Decoction may be considered as an alternative among patients unresponsive to conventional treatments. The comparative effectiveness of these two formulae should be evaluated in future trials.
ETHNOPHARMACOLOGICAL RELEVANCE: Conventional treatments for functional dyspepsia (FD) are limited. Herbal medicine (HM) use is prevalent despite unclear comparative effectiveness among different formulae. AIM OF THE STUDY: This network meta-analysis (NMA) aimed to evaluate the comparative effectiveness of HM formulae for FD against placebo. MATERIALS AND METHODS: Seven international and Chinese databases were searched for randomised controlled trials (RCTs) on HM versus placebo. Risk of bias among RCTs was assessed using Cochrane Risk-of-Bias Tool 2. Data from RCTs were extracted for random-effect pairwise meta-analyses. NMAs were performed to evaluate the comparative effectiveness of HM formulae. GRADE partially contextualised framework was adopted to facilitate NMA result interpretation. RESULTS: Twelve different HM formulae were identified from fifteen RCTs of mediocre quality. At 8-week follow-up, pairwise meta-analyses indicated that HM was superior to placebo in alleviating global symptoms (pooled risk difference (RD): 0.20; 95% confidence interval (CI): 0.11-0.29), with effect size larger than the minimally clinically important difference of 0.20 RD. Sensitivity analysis showed no significant impact on results attributable to risk of bias. NMAs demonstrated that Xiao Yao Pill and Modified Ban Xia Xie Xin Decoction probably have a large beneficial effect on alleviating global symptoms (RD: 0.37; 95% CI: 0.03-0.99) and postprandial fullness (standardised mean difference: -0.93; 95% credible interval: -1.61 to -0.06), respectively. No serious adverse events were reported. CONCLUSIONS: Xiao Yao Pill and Modified Ban Xia Xie Xin Decoction may be considered as an alternative among patients unresponsive to conventional treatments. The comparative effectiveness of these two formulae should be evaluated in future trials.
Authors: Leonard Ho; Claire C W Zhong; Charlene H L Wong; Justin C Y Wu; Karina K H Chan; Irene X Y Wu; Ting Hung Leung; Vincent C H Chung Journal: Chin Med Date: 2021-12-20 Impact factor: 5.455
Authors: Leonard Ho; Yulong Xu; Nevin L Zhang; Fai Fai Ho; Irene X Y Wu; Shuijiao Chen; Xiaowei Liu; Charlene H L Wong; Jessica Y L Ching; Pui Kuan Cheong; Wing Fai Yeung; Justin C Y Wu; Vincent C H Chung Journal: Chin Med Date: 2022-08-30 Impact factor: 4.546