Comparative Efficacy of Chinese Patent Medicines for Clearing Heat and Dampness in the Treatment of NAFLD: A Network Meta-Analysis of Real-World Evidence

Yuan Xu; Yan Wang; Xiao-Jun Gou; Man Wang

doi:10.1155/2022/4138555

Comparative Efficacy of Chinese Patent Medicines for Clearing Heat and Dampness in the Treatment of NAFLD: A Network Meta-Analysis of Real-World Evidence

Evid Based Complement Alternat Med. 2022 Jul 31:2022:4138555. doi: 10.1155/2022/4138555. eCollection 2022.

Authors

Yuan Xu^{1

2}, Yan Wang³, Xiao-Jun Gou², Man Wang⁴

Affiliations

¹ School of Pharmacy, Shaanxi University of Traditional Chinese Medicine, Xianyang 712046, Shaanxi, China.
² Central Laboratory, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai, Shanghai University of Traditional Chinese Medicine, Shanghai 201999, China.
³ Pharmacy Department, Shanghai Putuo District Liqun Hospital, Shanghai 200333, China.
⁴ Nutriology Department, Shanghai Fengxian District Central Hospital, Shanghai 201499, China.

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) has emerged as the most common chronic liver disease, as well as a worldwide medical problem with a substantial socioeconomic burden. In China, Chinese patent medicines (CPMs) have been widely utilized as promising and effective therapy options for NAFLD. Traditional Chinese medicine (TCM) is a particular kind of medical science reliant on real-world clinical practices and evidence. Therefore, using the real-world data extracted from pragmatic randomized controlled trials (PRCTs) have more reference value for the application of CPMs in NAFLD.

Method: Six databases were searched from their inception up to March 18, 2022. The methodological quality of the included study was evaluated by the Cochrane risk-of-bias tool. Then, The STATA 13.0 program was then used to do a network meta-analysis (NMA) of real-world studies. The surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the examined treatments.

Results: Forty-three PRCTs (4997 cases in total) were identified. Da-Huang-Li-Dan capsule (DHLD), Dan-Ning tablet (DN), Dang-Fei-Li-Gan-Ning capsule (DFLGN), Qiang-Gan capsule (QG), and Hua-Zhi-Rou-Gan granule (HZRG) were among the five CPMs tested. As far as the clinical effective rate of the primary outcome index was concerned, the top three CPMs were DN + CDs: OR = 0.19, 95% CIs: 0.12, 0.31 (SUCRA: 81.8%); DFLGN + CDs: OR = 0.21, 95% CIs: 0.09, 0.46 (SUCRA: 74.9%), and DHLD + CDs: OR = 0.26, 95% CIs: 0.10, 0.67 (SUCRA: 61.1%). In terms of liver function index, DN + CDs ranked first in ALT index: MD = 15.81, 95% CIs: 10.05, 21.57 (SUCRA: 85.5%), DFLGN + CDs ranked first in AST index: MD = 14.94, 95% CIs: 4.77, 25.11 (SUCRA: 83.6%), HZRG + CDs ranked first in TC index: MD = 0.53, 95% CIs: 0.28, 1.03 (SUCRA: 87.1%) and TG index: MD = 1.8, 95% CIs: 1.41, 2.30 (SUCRA: 79.9%).

Conclusion: Using CPMs as a coadjuvant treatment might be positive efficacious intervention from which patients with NAFLD will derive benefits. When it came to the clinical effective rate and other outcomes, DN + CDs demonstrated a significant improvement in individuals with NAFLD.