Background: The conventional therapy for chronic hepatitis C is the combination of interferon-alpha and ribavirin. However, it has some adverse effects and does not response to some patients, and it is also very expensive.
Objective: To assess the efficacy and safety of Chinese medicinal herbs for chronic hepatitis C virus infection.
Search strategy: Electronic and manual searches were conducted and the search ended in July 2009.
Inclusion criteria: We included randomized clinical trials testing Chinese herbal medicine vs placebo, non-specific treatment, antiviral treatment, or Chinese herbal medicine combined with antiviral treatment vs antiviral treatment alone.
Data extraction and analysis: Selection of trials for inclusion, assessment of methodological quality, data extraction and data syntheses were conducted according to the protocol of a Cochrane systematic review by the authors.
Results: Fifty-one randomized trials (involving 3 678 patients) with various methodological quality were included. The studies published in English had good quality, while studies published in Chinese were of poor quality. The pooled results showed that Chinese herbal medicine alone or in combination with antiviral treatment was generally better than non-specific treatment or antiviral treatment alone, and herbal medicine appeared equal to antiviral treatment regarding comprehensive clinical effect in terms of symptoms, liver function and virological response. Regarding virological response including loss of serum hepatitis C virus (HCV) RNA and anti-HCV antibodies, herbal medicine was better than non-specific treatment, equal to antiviral treatment, and the combination of herbs and antiviral treatment was better than antiviral treatment alone. Similar positive findings were found for liver function improvement. Adverse effects were observed among herbal injections and interferon treatment, and few cases had severe adverse effects.
Conclusion: Herbal medicines included in this review have effects in improving symptoms, liver function, and loss of HCV markers in patients with chronic hepatitis C. However, for majority of the included trials were published in Chinese and had low quality, the promising effects from some herbs need to be confirmed in rigorous clinical trials, and the design and reporting of trials should follow international standards.
Systematic review registration: http://www.cochrane.org, 380700081611301089.