Efficacy and safety of Shenqi Dihuang decoction for lupus nephritis: A systematic review and meta-analysis

Dan Li; Bei Pan; Ning Ma; Xiaoman Wang; Xiyuan Deng; Honghao Lai; Long Ge; Junqiang Niu; Kehu Yang

doi:10.1016/j.jep.2023.117602

Efficacy and safety of Shenqi Dihuang decoction for lupus nephritis: A systematic review and meta-analysis

J Ethnopharmacol. 2024 Apr 6:323:117602. doi: 10.1016/j.jep.2023.117602. Epub 2023 Dec 27.

Authors

Dan Li¹, Bei Pan¹, Ning Ma¹, Xiaoman Wang¹, Xiyuan Deng², Honghao Lai³, Long Ge⁴, Junqiang Niu⁵, Kehu Yang⁶

Affiliations

¹ Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
² Department of Prenatal Diagnosis Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, 730000, China.
³ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.
⁴ Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China.
⁵ Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China; The First Hospital of Lanzhou University, Lanzhou, 730000, China. Electronic address: njqldyy@126.com.
⁶ Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China. Electronic address: yangkh-ebm@lzu.edu.cn.

PMID: 38158100
DOI: 10.1016/j.jep.2023.117602

Abstract

Ethnopharmacological relevance: Lupus Nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE). However, the treatment of lupus nephritis using traditional Chinese medicine remains controversial.

Aim of the study: To assess the efficacy and safety of Shenqi Dihuang decoction in the treatment of LN and review the clinical guidelines.

Materials and methods: Six databases (China National Knowledge Infrastructure, Wanfang, PubMed, China Biology Medicine, the Cochrane Library, and Embase) were searched from their inception to September 10, 2022, for randomized controlled trials on the treatment of lupus nephritis using Shenqi Dihuang decoction. We conducted a meta-analysis of random effects using Review Manager 5.4 and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results: A total of 15,790 citations were identified, from which 14 eligible randomized controlled trials that enrolled 1002 participants were selected for this systematic review. Low-to-moderate certainty of evidence indicated that when compared with Western medicine, Shenqi Dihuang decoction combined with Western medicine was associated with favorable effects on clinical efficacy (risk ratio (RR) = 1.25, 95% confidence interval (CI): 1.15-1.37), vascular endothelial growth factor (mean difference (MD) = -30.90, 95% CI: -40.18 to -21.63), serum level (MD = -4.81 μmol L^-1, 95% CI: -17.14 to 7.53), complement C3 (MD = -0.14 g L^-1, 95% CI: -0.23 to -0.04), erythrocyte sedimentation rate (MD = -11.87 mm h^-1, 95% CI: -22.01 to -1.73), and SLE disease activity score (MD = -3.38, 95% CI: -4.15 to -2.61), and exhibited a lower risk of infection (RR = 0.2, 95% CI: 0.05-0.90), gastrointestinal reaction (RR = 0.47, 95% CI: 0.17-1.28), and insomnia (RR = 0.29, 95% CI: 0.09-0.92).

Conclusions: This systematic review provides a potential reference for understanding the efficacy and safety of Shenqi Dihuang decoction combined with Western medicine for treating patients with lupus nephritis. However, owing to the limited quality of the studies included in this review, lack of mycophenolate mofetil control, and high heterogeneity among the included studies, the current findings should be interpreted with caution. Therefore, the efficacy and safety of Shenqi Dihuang decoction in patients with PN still require further verification through future high-quality clinical studies.

Keywords: Ethnic medicine; Lupus nephritis; Meta-analysis; Shenqi Dihuang decoction; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Drugs, Chinese Herbal* / adverse effects
Humans
Lupus Erythematosus, Systemic* / drug therapy
Lupus Nephritis* / drug therapy
Randomized Controlled Trials as Topic
Vascular Endothelial Growth Factor A

Substances

Drugs, Chinese Herbal
shenqi
Vascular Endothelial Growth Factor A