PMID- 37263317 OWN - NLM STAT- MEDLINE DCOM- 20230824 LR - 20230824 IS - 1872-7573 (Electronic) IS - 0378-8741 (Linking) VI - 317 DP - 2023 Dec 5 TI - Five Tibetan patent medicines orally for ischemic stroke: A systematic review and meta-analysis of randomized controlled trials. PG - 116671 LID - S0378-8741(23)00539-1 [pii] LID - 10.1016/j.jep.2023.116671 [doi] AB - ETHNOPHARMACOLOGICAL RELEVANCE: Tibetan Patent Medicines (TPMs) have unique advantages in the treatment of ischemic stroke (IS) with the features of multi-component, multi-channel, and multi-target. In China, five TPMs mainly consisting of precious medicinal materials such as gold, pearls, and agate are widely utilized to treat IS and have achieved good results according to the current clinical practice. AIM OF THE STUDY: To systematically evaluate the efficacy and safety of the five TPMs orally in treating IS and provide a reference for future clinical application and research. MATERIALS AND METHODS: We searched the following 24 databases up to December 11, 2022: China National Knowledge Infrastructure (CNKI), Wanfang database, China Science and Technology Journal Database, Chinese Biomedical Database (CBM), PubMed, Embase, Web of Science, MEDLINE, Scopus, the Cochrane Library, ScienceDirect, etc. Comprehensive searches for randomized controlled trials (RCTs) of the five TPMs for IS were conducted. Outcome measures included clinical effective rate, neurological impairment score, activities of daily living (ADL), hematologic indices, and adverse events (AEs). The meta-regression, subgroup analyses, and sensitivity analyses were conducted to explore the sources of heterogeneity. We assessed the evidence grade of outcomes via the GRADE system. TSA software was used for trial sequential analyses of the clinical effective rate, neurological impairment score, and ADL. RESULTS: 17 RCTs (1603 patients) met our criteria. Compared with the control groups, the five TPMs showed greater improvement in clinical effective rate (RR = 1.23, 95% CI 1.17 to 1.29, P < 0.00001), neurological impairment score (SMD = -1.71, 95% CI -2.31 to -1.10, P < 0.00001), ADL (SMD = 1.97, 95% CI 1.26 to 2.68, P < 0.00001), hematocrit (MD = -1.56, 95% CI -2.83 to -0.29, P = 0.02), and hypersensitive-c-reactive-protein (MD = -2.96, 95% CI -3.30 to -2.61, P < 0.00001). AEs were reported in four RCTs and there was no statistical difference between groups (RD = -0.00, 95% CI -0.04 to 0.03, P = 0.82). The quality of evidence of the outcomes was rated as low to very low according to the GRADE system. The results of TSA provided firm evidence for the significant effect of the five TPMs on clinical effective rate, neurological impairment score, and ADL. CONCLUSIONS: This review showed that the five TPMs were beneficial in improving clinical effective rate, neurological impairment scores, and ADL. However, no definite conclusions for hematologic indices and AEs were drawn due to insufficient studies. Further high-quality clinical trials are required to confirm these findings. CI - Copyright (c) 2023. Published by Elsevier B.V. FAU - Zhang, Xu-Ran AU - Zhang XR AD - Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China; Beijing University of Chinese Medicine, Beijing, 100029, China. Electronic address: a3162584610@163.com. FAU - Zang, Shu-Han AU - Zang SH AD - Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China; Beijing University of Chinese Medicine, Beijing, 100029, China. Electronic address: 1339550999@qq.com. FAU - Zou, Hong-Xin AU - Zou HX AD - Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China; Beijing University of Chinese Medicine, Beijing, 100029, China. Electronic address: 17888808848@163.com. FAU - Zhu, Li-Hong AU - Zhu LH AD - Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China; Beijing University of Chinese Medicine, Beijing, 100029, China. Electronic address: 2524016738@qq.com. FAU - Sha, Ri-Na AU - Sha RN AD - Beijing University of Chinese Medicine, Beijing, 100029, China. Electronic address: 1751806160@qq.com. FAU - Liu, Bo-Wen AU - Liu BW AD - Beijing University of Chinese Medicine, Beijing, 100029, China. Electronic address: drliubowen@163.com. FAU - Dong, Xing-Lu AU - Dong XL AD - Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China. Electronic address: arthasdxl@163.com. FAU - Zhou, Li AU - Zhou L AD - Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China. Electronic address: zhouljk7211@163.com. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20230531 PL - Ireland TA - J Ethnopharmacol JT - Journal of ethnopharmacology JID - 7903310 SB - IM MH - Humans MH - Tibet MH - Randomized Controlled Trials as Topic MH - Treatment Outcome MH - *Ischemic Stroke/drug therapy MH - China OTO - NOTNLM OT - Ischemic Stroke OT - Meta-analysis OT - Systematic review OT - Tibetan patent medicine OT - Trial sequential analysis COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/06/02 01:07 MHDA- 2023/08/24 06:43 CRDT- 2023/06/01 19:21 PHST- 2022/06/27 00:00 [received] PHST- 2023/01/24 00:00 [revised] PHST- 2023/05/20 00:00 [accepted] PHST- 2023/08/24 06:43 [medline] PHST- 2023/06/02 01:07 [pubmed] PHST- 2023/06/01 19:21 [entrez] AID - S0378-8741(23)00539-1 [pii] AID - 10.1016/j.jep.2023.116671 [doi] PST - ppublish SO - J Ethnopharmacol. 2023 Dec 5;317:116671. doi: 10.1016/j.jep.2023.116671. Epub 2023 May 31.