Therapeutic effect of Chinese herbal medicines for post stroke recovery: A traditional and network meta-analysis.
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SUBMITTER: Han SY
PROVIDER: S-EPMC5728860 | biostudies-literature | 2017 Dec
REPOSITORIES: biostudies-literature
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Therapeutic effect of Chinese herbal medicines for post stroke recovery: A traditional and network meta-analysis.
Han Shi-You SY Hong Zhi-You ZY Xie Yu-Hua YH Zhao Yong Y Xu Xiao X
Medicine 20171201 49
<h4>Background</h4>Stroke is a condition with high morbidity and mortality, and 75% of stroke survivors lose their ability to work. Stroke is a burden to the family and society. The purpose of this study was to evaluate the effectiveness of Chinese herbal patent medicines in the treatment of patients after the acute phase of a stroke.<h4>Methods</h4>We searched the following databases through August 2016: PubMed, Embase, Cochrane library, China Knowledge Resource Integrated Database (CNKI), Chin ...[more]
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Project description:BackgroundPost-stroke depression (PSD) is common in stroke survivors, with significantly negative effects and serious impairments in terms of personal and social functioning. While both pharmacological and traditional Chinese medicine (TCM) interventions have been administered for PSD, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank, describing the protocol of a systematic review and network meta-analysis (NMA), the commonly used TCM interventions for PSD.Methods and analysisWe will search CENTRAL (the Cochrane Central Register of Controlled Trials), CINAHL, Embase, PubMed, CBM and PsycINFO, the US National Institutes of Health and the World Health Organisation International Trials Registry Platform search portal from inception to November 2018. There will be no restrictions on language, publication year or publication type. Only randomized clinical trials (RCTs) accessing any TCM treatments against active comparator or other controls for PSD will be included. The primary outcomes will be efficacy (the total number of participants, declining more than 50% on the total score between baseline) and acceptability of treatment (dropout rate due to any cause). A Bayesian NMA will be performed to compare all relative outcome of different TCM interventions. we will conduct the network meta-regression meta-analyses of data on the sex ratio, the types of stroke and the treatment duration of TCM interventions. Potential explanations in extra subgroup analyses according to the results of heterogeneity and inconsistency will be explored, and sensitivity analyses will be conducted to assess the robustness of the findings.Trials registration numberPROSPERO CRD42018082400.ConclusionOur study will generate evidence for TCM in the treatment of PSD and help to reduce the uncertainty about the effectiveness of PSD management, which will encourage further suggestions for TCM clinical practice or guideline.
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Project description:As a well-established multidrug combinations schema, traditional Chinese medicine (herbal prescription) has been used for thousands of years in real-world clinical settings. This paper uses a complex network approach to investigate the regularities underlying multidrug combinations in herbal prescriptions. Using five collected large-scale real-world clinical herbal prescription datasets, we construct five weighted herbal combination networks with herb as nodes and herbal combinational use in herbal prescription as links. We found that the weight distribution of herbal combinations displays a clear power law, which means that most herb pairs were used in low frequency and some herb pairs were used in very high frequency. Furthermore, we found that it displays a clear linear negative correlation between the clustering coefficients and the degree of nodes in the herbal combination network (HCNet). This indicates that hierarchical properties exist in the HCNet. Finally, we investigate the molecular network interaction patterns between herb related target modules (i.e., subnetworks) in herbal prescriptions using a network-based approach and further explore the correlation between the distribution of herb combinations and prescriptions. We found that the more the hierarchical prescription, the better the corresponding effect. The results also reflected a well-recognized principle called "Jun-Chen-Zuo-Shi" in TCM formula theories. This also gives references for multidrug combination development in the field of network pharmacology and provides the guideline for the clinical use of combination therapy for chronic diseases.
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Project description:BackgroundAcute ischemic stroke (AIS) is characterized by high morbidity, disability, mortality, recurrence, and economic burden. Clinical trials have demonstrated that the clinical efficacy of combining oral Chinese patent medicines (CPMs) with chemical drugs (CDs) is better than that of CDs alone. In this study, we performed a network meta-analysis (NMA) of RCTs to assess the efficacy of different CPMs in combination with CDs in the treatment of AIS.MethodsSearch 6 databases from the beginning to January 10, 2023. The Cochrane Risk of Bias tool assessed the methodological quality of the included studies. The NMA was then performed using the STATA 13.0 program. The surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the studied treatments, and cluster analysis was used to compare the effects of CPMs between 2 different outcomes.ResultsA total of 94 eligible RCTs, involving 9581 participants, were included in this analysis. Nine CPMs, including Nao-mai-li granule (NML), Nao-mai-tai granule (NMT), Qi-long granule (QL), Long-sheng-zhi capsule (LSZ), Nao-xin-tong capsule (NXT), Nao-xue-shu oral liquid (NXS), Tong-xin-luo capsule (TXL), Xiao-shuan-chang-rong capsule (XSCR), and Xue-shuan-xin-mai-ning capsule (XSXMN) were included. Regarding the clinical effective rate, all types of CPMs + CDs treatments were significantly better than CDs treatments alone, with significant differences among the 9 selected CPMs. Compared with CDs, results showed that NXS + CDs performed best in improving clinical effective rate [OR = 4.73; 95% CI: 1.26-17.78; (SUCRA: 76.1%)]. TXL + CDs showed the most effective effect in alleviating National Institutes of Health Stroke Scale (NIHSS) [MD = -3.84; 95% CI: -5.23, -2.45; (SUCRA: 81.6%)]; NXT + CDs were most effective in improving Barthel index [MD = 13.05; 95% CI: 3.98-22.12; (SUCRA: 63.5%)]. Combined with other outcome indicators and the results of cluster analysis, NXS + CDs may assist in the potential optimal treatment regimen for AIS.ConclusionIn conclusion, CPMs were found to be beneficial as adjuvant therapy in patients with AIS. Taking into account the clinical effective rate and other outcomes, NXS + CDs may be the most effective option to improve the condition of AIS patients.
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Project description:Post-stroke insomnia (PSI) is a highly prevalent complication after stroke. Current evidence of psychotropic drug use for PSI management is scarce and indicates harmful adverse events (AEs). Traditional East Asian herbal medicine is a widely used traditional remedy for insomnia. However, so far, no study has systematically reviewed the efficacy and safety of traditional east asian herbal medicine (HM) for PSI. Therefore, we perform meta-analysis to evaluate the effectiveness and safety of HM for PSI. After a comprehensive electronic search of 15 databases, we review the randomized controlled trials (RCTs) of HM use as monotherapy for PSI. Our outcomes were the Pittsburgh sleep quality index and total effective rate. In total, 24 RCTs were conducted with 1942 participants. HM showed statistically significant benefits in sleep quality. It also appeared to be safer than psychotropic drugs in terms of AEs, except when the treatment period was two weeks. The methods used for RCTs were poor, and the quality of evidence assessed was graded "low" or "moderate." The findings of this review indicate that the use of HM as a monotherapy may have potential benefits in PSI treatment when administered as an alternative to conventional medications. However, considering the methodological quality of the included RCTs, we were uncertain of the clinical evidence. Further, well-designed RCTs are required to confirm these findings.
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