Efficacy and safety of integrated traditional Chinese and Western medicine against COVID-19: A systematic review and meta-analysis

Abstract

Although plenty of clinical trials have confirmed the efficacy and safety of integrated traditional Chinese and Western medicine (ITCWM) against COVID-19, the role of ITCWM remains controversial. So we conducted a systematic review and meta-analysis of published studies in eight major databases that report the outcomes of interest in COVID-19 patients receiving ITCWM. RevMan5.4 software was used for meta-analysis, while the quality of RCTs was assessed by the Cochrane risk of bias tool and the retrospective studies were assessed by Newcastle-Ottawa Scale. Eventually, a total of 53 studies with 5425 COVID-19 patients was identified. The meta-analysis results showed that ITCWM was significantly better than western medicine treatment (WMT) alone in the percentage of cases changing to severe/critical [RR = 0.40, 95%CI (0.33, 0.49), p < .00001, I² = 10%], overall clinical effectiveness [RR = 1.26, 95% CI (1.18, 1.35), p < .00001, I² = 50%], time to defervescencer [MD = -1.45, 95% CI (-1.82, -1.07), p < .00001, I² = 83%], disappearing time of cough [MD = -2.11, 95% CI (-2.98, -1.25), p < .00001, I² = 93%], time of RT-PCR negativity [MD = -3.35, 95% CI (-4.74, -1.95), p < .00001, I² = 92%], length of hospital stay [MD = -4.05, 95% CI (-5.24, -2.85), p < .00001, I² = 91%], improvement in CT scan [RR = 1.22, 95% CI (1.17, 1.28), p < .00001, I² = 46%], TCM syndrome score [MD = -3.95, 95% CI (-5.07, -2.82), p < .00001, I² = 92%], disappearance rate of fever [RR = 1.23, 95% CI (1.10, 1.38), p < .00001, I² = 85%], disappearance rate of cough [RR = 1.43, 95% CI (1.25, 1.63), p < .00001, I² = 60%], level of CRP [MD = -9.23, 95% CI (-10.94, -7.52), p < .00001, I² = 97%], and WBC [MD = -9.23, 95% CI (-10.94, -7.52), p < .00001, I² = 97%]. There is no significant difference between ITCWM and WMT in the adverse reaction rate [RR = 0.85, 95% CI(0.71, 1.03), p = .10, I² = 25%]. Our results showed evidence of clinical efficacy and safety benefit in COVID-19 patients treated with ITCWM. In spite of some limitations, the rapidly developing global pandemic warrants further high-quality and multicenter clinical studies to confirm the contribution of ITCWM.

Keywords: COVID-19; integrated traditional Chinese and Western medicine; meta-analysis; randomized controlled trial; systematic review.