Oniyangi Oluseyi, Cohall Damian H
Paediatrics Department, National Hospital, Plot 132 Central District (Phase II), PMB 425 Garki, Abuja, Nigeria.
Cochrane Database Syst Rev. 2015 Apr 6(4):CD004448. doi: 10.1002/14651858.CD004448.pub5.
Sickle cell disease, a common recessively inherited haemoglobin disorder, affects people from sub-Saharan Africa, the Middle East, Mediterranean basin, Indian subcontinent, Caribbean and South America. It is associated with complications and a reduced life expectancy. Phytomedicines (medicine derived from plants in their original state) encompass many of the plant remedies from traditional healers which the populations most affected would encounter. There has been little systematic appraisal of their benefits. This is an update of a Cochrane Review first published in 2010 and updated in 2013.
To assess the benefits and risks of phytomedicines in people with sickle cell disease of all types, of any age, in any setting.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, the International Standard Randomised Controlled Trial Number Register (ISRCTN) and the Allied and Complimentary Medicine Database (AMED).Dates of most recent searches: Haemoglobinopathies Trials Register: 13 October 2014;
17 January 2015; AMED: 20 January 2015.
Randomised or quasi-randomised trials with participants of all ages with sickle cell disease, in all settings, comparing the administration of phytomedicines, by any mode to placebo or conventional treatment, including blood transfusion and hydroxyurea.
Both authors independently assessed trial quality and extracted data.
Two trials (182 participants) and two phytomedicines Niprisan(®) (also known as Nicosan(®)) and Ciklavit(®) were included. The Phase IIB (pivotal) trial suggests that Niprisan(®) was effective in reducing episodes of severe painful sickle cell disease crisis over a six-month period. It did not affect the risk of severe complications or the level of anaemia. No serious adverse effects were reported. The single trial of Cajanus cajan (Ciklavit(®)) reported a possible benefit to individuals with painful crises, and a possible adverse effect (non-significant) on the level of anaemia.
AUTHORS' CONCLUSIONS: While Niprisan(®) appeared to be safe and effective in reducing severe painful crises over a six-month follow-up period, further trials are required to assess its role in the management of people with sickle cell disease and the results of its multicentre trials are awaited. Currently no conclusions can be made regarding the efficacy of Ciklavit(®). Based on the published results for Niprisan(®) and in view of the limitations in data collection and analysis of both trials, phytomedicines may have a potential beneficial effect in reducing painful crises in sickle cell disease. This needs to be further validated in future trials. More trials are required on the safety and efficacy of phytomedicines used in managing sickle cell disease.
镰状细胞病是一种常见的隐性遗传性血红蛋白疾病，影响撒哈拉以南非洲、中东、地中海盆地、印度次大陆、加勒比地区和南美洲的人群。它与并发症相关且预期寿命缩短。植物药（源自原始状态植物的药物）包含了许多受影响人群会接触到的传统治疗师使用的植物疗法。对其益处的系统评估很少。这是一篇Cochrane系统评价的更新，该评价首次发表于2010年，2013年进行了更新。
评估植物药对所有类型、任何年龄、任何环境下的镰状细胞病患者的益处和风险。
我们检索了Cochrane囊性纤维化和遗传性疾病组血红蛋白病试验注册库、国际标准随机对照试验编号注册库（ISRCTN）以及补充和替代医学数据库（AMED）。最近的检索日期：血红蛋白病试验注册库：2014年10月13日；ISRCTN：2015年1月17日；AMED：2015年1月20日。
随机或半随机试验，参与者为所有年龄的镰状细胞病患者，在所有环境下，比较以任何方式给予植物药与安慰剂或传统治疗（包括输血和羟基脲）。
两位作者独立评估试验质量并提取数据。
纳入了两项试验（182名参与者）以及两种植物药Niprisan®（也称为Nicosan®）和Ciklavit®。IIB期（关键）试验表明，Niprisan®在六个月期间有效减少了严重疼痛性镰状细胞病危机的发作次数。它没有影响严重并发症的风险或贫血水平。未报告严重不良反应。关于木豆（Ciklavit®）的单项试验报告称，对疼痛危机患者可能有益，对贫血水平可能有不良影响（无统计学意义）。
虽然Niprisan®在六个月的随访期内似乎安全有效，可减少严重疼痛性危机，但需要进一步试验来评估其在镰状细胞病患者管理中的作用，并且正在等待其多中心试验的结果。目前关于Ciklavit®的疗效无法得出结论。基于Niprisan®已发表的结果，鉴于两项试验在数据收集和分析方面的局限性，植物药在减少镰状细胞病疼痛危机方面可能具有潜在的有益作用。这需要在未来的试验中进一步验证。需要更多关于用于管理镰状细胞病的植物药的安全性和疗效的试验。
