Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 102488, China.
BMC Complement Med Ther. 2020 Jul 6;20(1):210. doi: 10.1186/s12906-020-03004-4.
Rheumatoid arthritis (RA) is a common inflammatory disease with a substantial burden for society and economic worldwide. Chinese patent medicines (CPMs) have gained attention as alternative remedies due to they can exert the satisfactory therapeutic effects via holistic regulation. Currently, several oral Chinese patent medicines are routinely recommended for managing and treating RA. Therefore, a network meta-analysis (NMA), which tries to synthesize evidences for a decision making by evaluating the comparative effectiveness of multiple interventions against the same disease, was undertaken to identify the optimal intervention according to their efficacy in clinical treatment and symptom remission, safety profile and daily cost.
Randomized controlled trials (RCTs) regarding CPMs to treat RA were comprehensive retrieved from 3 foreign databases and 4 Chinese databases, and the retrieved results were last updated on January 10, 2019. The bias of the selected trials was assessed by two individuals independently through RoB2. A random-effects model was adopted during the meta-analytic procedures, and outcomes concerning efficacy and safety were evaluated as odds ratios (OR), mean differences (MD) and 95% credible intervals (CI) utilizing Stata 14.1 and WinBUGS 1.4.3 software. Furthermore, the cluster analysis and comprehensive investigation were preformed concerning the comparative efficacy, safety and cost of oral CPMs.
One hundred sixteen RCTs involving 10,213 individuals met the inclusion criteria and were enrolled into current NMA. The results from existing evidence indicated that Biqi capsule and Yuxuebi capsule probably had a favorable balance in consideration of benefits, tolerability and daily cost. Furthermore, as the least expensive choice, glucosides of Tripterygium Wilfordii tablet was associated with displaying a trend of relieving joint tenderness, joint swelling, and morning stiffness for patients with RA.
Biqi capsule, Yuxuebi capsule and glucosides of Tripterygium Wilfordii tablet were recommended for treating RA based on the favorable benefits in both clinical efficacy and symptoms, and they, meanwhile, might be associated with the more tolerable and acceptable therapeutic alternative in terms of safety profile and daily cost. Nevertheless, the additional results from high-quality, multi-center and head-to-head trials would be pivotal for supporting our findings.
类风湿关节炎（RA）是一种常见的炎症性疾病，给全球社会和经济带来了巨大负担。中药成药（CPM）因其通过整体调节发挥令人满意的治疗效果而受到关注。目前，几种口服中药成药常规推荐用于管理和治疗 RA。因此，进行了网络荟萃分析（NMA），试图通过评估多种干预措施对同一疾病的相对疗效来综合证据以做出决策，以确定根据其在临床治疗和症状缓解、安全性概况和日常成本方面的疗效，最佳干预措施。
从 3 个外文数据库和 4 个中文数据库全面检索了关于 CPM 治疗 RA 的随机对照试验（RCT），检索结果最后更新于 2019 年 1 月 10 日。通过 RoB2 由两名独立人员评估选定试验的偏倚。在荟萃分析过程中采用随机效应模型，使用 Stata 14.1 和 WinBUGS 1.4.3 软件评估疗效和安全性结局的比值比（OR）、均数差（MD）和 95%可信区间（CI）。此外，还针对口服 CPM 的比较疗效、安全性和成本进行了聚类分析和综合调查。
纳入了 116 项 RCT，涉及 10213 人，进行了当前的 NMA。现有证据的结果表明，芪苈强心胶囊和瘀血痹胶囊可能在获益、耐受性和日常成本方面具有较好的平衡。此外，作为最便宜的选择，雷公藤多苷片对于 RA 患者缓解关节压痛、关节肿胀和晨僵有一定趋势。
根据临床疗效和症状方面的良好获益，芪苈强心胶囊、瘀血痹胶囊和雷公藤多苷片被推荐用于治疗 RA，同时它们在安全性概况和日常成本方面可能与更可耐受和更可接受的治疗选择相关。然而，来自高质量、多中心和头对头试验的额外结果将对支持我们的发现至关重要。
