Pinellia ternata-containing traditional Chinese medicine combined with 5-HT3RAs for chemotherapy-induced nausea and vomiting: A PRISMA-compliant systematic review and meta-analysis of 22 RCTs

Xiangyang Zhai; Qida He; Min Chen; Lili Yu; Chiin Tong; Ying Chen; Jue Wang; Xingxing Fan; Han Xie; Zimao Liang; Xinbing Sui; Li Zeng; Qibiao Wu

doi:10.1016/j.phymed.2023.154823

Pinellia ternata-containing traditional Chinese medicine combined with 5-HT3RAs for chemotherapy-induced nausea and vomiting: A PRISMA-compliant systematic review and meta-analysis of 22 RCTs

Phytomedicine. 2023 Jul:115:154823. doi: 10.1016/j.phymed.2023.154823. Epub 2023 Apr 14.

Authors

Xiangyang Zhai¹, Qida He², Min Chen², Lili Yu², Chiin Tong², Ying Chen³, Jue Wang², Xingxing Fan², Han Xie¹, Zimao Liang¹, Xinbing Sui⁴, Li Zeng⁵, Qibiao Wu⁶

Affiliations

¹ Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, China; College of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang, China; Department of Medical Oncology, the Affiliated Hospital of Hangzhou Normal University, College of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
² Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, China.
³ School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
⁴ Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, China; College of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang, China; Department of Medical Oncology, the Affiliated Hospital of Hangzhou Normal University, College of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China. Electronic address: hzzju@hznu.edu.cn.
⁵ Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, China. Electronic address: lzeng@must.edu.mo.
⁶ Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, China; Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangdong University of Technology, Guangzhou, Guangdong, China; Zhuhai MUST Science and Technology Research Institute, Zhuhai, Guangdong, China. Electronic address: qbwu@must.edu.mo.

PMID: 37099981
DOI: 10.1016/j.phymed.2023.154823

Abstract

Background: Pinellia ternata (P. ternata, Banxia)-containing traditional Chinese medicine (TCM) is widely used in China as an adjuvant treatment for chemotherapy-induced nausea and vomiting (CINV). However, evidence of its efficacy and safety remains limited.

Purpose: To investigate the efficacy and safety of P. ternata-containing TCM combined with 5-hydroxytryptamine-3 receptor antagonists (5-HT3RAs) in the treatment of CINV.

Study design: Systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: All relevant RCTs were systematically retrieved from seven internet databases (up to February 10, 2023). P. ternata-containing TCM combined with 5-HT3RAs to treat CINV was included in all RCTs. The clinical effective rate (CER) was defined as the primary outcome, while appetite, quality of life (QOL), and side effects were secondary outcomes.

Results: The meta-analysis included 22 RCTs with 1,787 patients. Our results indicated that P. ternata-containing TCM combined with 5-HT3RAs significantly improved the CER of CINV (RR = 1.46, 95% CI = 1.37-1.57, p < 0.00001), appetite (RR = 1.77, 95% CI = 1.42-2.20, p < 0.00001), QOL (RR = 7.67, 95% CI = 1.56-13.78, p = 0.01), the CER of several 5-HT3RA medications (RR = 1.47, 95% CI = 1.37-1.57, p < 0.00001), and acute and delayed vomiting (RR = 1.23, 95% CI = 1.12-1.36, p < 0.0001) compared with the 5-HT3RAs alone, while the combination therapy decreased the incidence of side effects induced by 5-HT3RAs for CINV (RR = 0.50, 95% CI = 0.42-0.59, p < 0.00001).

Conclusion: According to the findings of this systematic review and meta-analysis, P. ternata-containing TCM combined with 5-HT3RAs was safer and more effective than 5-HT3RAs alone for CINV patients. However, due to the limitations of the included studies, more high-quality clinical trials are required to further validate our findings.

Keywords: Chemotherapy-induced nausea and vomiting; Meta-analysis; Pinellia ternata; Systematic review; Traditional Chinese medicine.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Antineoplastic Agents* / therapeutic use
Humans
Medicine, Chinese Traditional / adverse effects
Nausea / chemically induced
Nausea / drug therapy
Pinellia*
Vomiting / chemically induced
Vomiting / drug therapy

Substances

Antineoplastic Agents