PMID- 34353032
OWN - NLM
STAT- MEDLINE
DCOM- 20210809
LR  - 20210809
IS  - 2224-5839 (Electronic)
IS  - 2224-5820 (Linking)
VI  - 10
IP  - 7
DP  - 2021 Jul
TI  - Comparative efficacy and safety of four classical prescriptions for clearing 
      damp-heat recommended by clinical guidelines in treating rheumatoid arthritis: a 
      network meta-analysis.
PG  - 7298-7328
LID - 10.21037/apm-21-445 [doi]
AB  - BACKGROUND: In China, along with conventional synthetic disease-modifying 
      anti-rheumatic drugs (csDMARDs), some herbal formulae for clearing damp-heat are 
      widely applied in treating rheumatoid arthritis (RA). We aimed to summarize and 
      compare the clinical effects of 4 guideline-recommended formulae, including 
      Baihuguizhi decoction, Dangguiniantong decoction, Simiao pill, and Xuanbi 
      decoction. METHODS: PubMed, Cochrane Library, EMBASE, Chinese National Knowledge 
      Infrastructure (CNKI), Chinese Science and Technique Journals (CQVIP), WanFang, 
      and SinoMed (CBM) databases were searched for randomized controlled trials from 
      inception to July 2020 evaluating the efficacy and safety of these recommended 
      herbal formulae combined with 1 csDMARD versus csDMARD alone in RA patients. A 
      pairwise meta-analysis was conducted in RevMan 5.3 software, and a Bayesian 
      network meta-analysis (NMA) was performed with Stata 14.0, R 4.0.2, GeMTC 0.14.3, 
      and JAGS 4.3.0 software. Cochrane Handbook 5.1.0 was used to assess the risk of 
      bias. Publication bias was evaluated using Egger's test, the trim-fill 
      adjustment, and funnel plots. Trial sequential analysis (TSA) was performed to 
      validate the overall results. The rank probability of interventions was 
      calculated and clustered by the surface under the cumulative ranking curve 
      (SUCRA). Pharmacologic actions of formulae were explored through the network 
      pharmacology approach. RESULTS: A total of 15 studies, including 1,079 
      individuals, were identified. Simiao pill + csDMARD [SMPPD, odds ratio (OR) 
      =6.62, 95% confidence interval (CI): 2.88 to 16.84] was superior to csDMARDs 
      alone in clinical efficiency, and was more able to reduce C-reactive protein and 
      erythrocyte sedimentation rate levels [mean difference (MD) =-7.91, 95% CI: 
      -17.41 to -1.25; MD =-9.31, 95% CI: -14.48 to -5.56 respectively]. Although 
      publication bias was observed (P=0.033), the trim-fill method indicated that the 
      pooled values kept stable. Fewer adverse events (AEs) were shown with SMPPD 
      (6.45%). TSA confirmed the results of efficacy rate at SMPPD. Network 
      pharmacology included 5 common components and 66 common targets among 4 formulae 
      in treating RA, involving regulating immunity and relieving inflammation. 
      DISCUSSION: SMPPD might be a preferable complementary therapy for RA. However, 
      considering the limitations of this study, recommendations for clinical practice 
      should be validated by the results of further well-designed studies.
FAU - Li, Shaowei
AU  - Li S
AD  - Department of Traditional Chinese Medicine, General Hospital of Southern Theater 
      Command of PLA, Guangzhou, China; Guangzhou University of Chinese Medicine, 
      Guangzhou, China.
FAU - Liu, Dandan
AU  - Liu D
AD  - Department of Traditional Chinese Medicine, General Hospital of Southern Theater 
      Command of PLA, Guangzhou, China; Guangzhou University of Chinese Medicine, 
      Guangzhou, China.
FAU - Chen, Zhihuang
AU  - Chen Z
AD  - Department of Traditional Chinese Medicine, General Hospital of Southern Theater 
      Command of PLA, Guangzhou, China.
FAU - Wei, Song
AU  - Wei S
AD  - Department of Traditional Chinese Medicine, General Hospital of Southern Theater 
      Command of PLA, Guangzhou, China.
FAU - Xu, Wei
AU  - Xu W
AD  - Department of Traditional Chinese Medicine, General Hospital of Southern Theater 
      Command of PLA, Guangzhou, China.
FAU - Li, Xiaohao
AU  - Li X
AD  - Department of Traditional Chinese Medicine, General Hospital of Southern Theater 
      Command of PLA, Guangzhou, China.
FAU - Wei, Qipeng
AU  - Wei Q
AD  - Guangzhou University of Chinese Medicine, Guangzhou, China; Department of 
      Orthopaedics, Panyu Hospital of Traditional Chinese Medicine, Guangzhou, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - China
TA  - Ann Palliat Med
JT  - Annals of palliative medicine
JID - 101585484
SB  - IM
MH  - *Arthritis, Rheumatoid/drug therapy
MH  - Bayes Theorem
MH  - *Hot Temperature
MH  - Humans
MH  - Network Meta-Analysis
MH  - Prescriptions
OTO - NOTNLM
OT  - Chinese herbal formula
OT  - network meta-analysis (NMA)
OT  - network pharmacology
OT  - rheumatoid arthritis (RA)
EDAT- 2021/08/07 06:00
MHDA- 2021/08/10 06:00
CRDT- 2021/08/06 05:27
PHST- 2021/02/24 00:00 [received]
PHST- 2021/06/09 00:00 [accepted]
PHST- 2021/08/06 05:27 [entrez]
PHST- 2021/08/07 06:00 [pubmed]
PHST- 2021/08/10 06:00 [medline]
AID - 10.21037/apm-21-445 [doi]
PST - ppublish
SO  - Ann Palliat Med. 2021 Jul;10(7):7298-7328. doi: 10.21037/apm-21-445.