Jun Ji Hee, Ang Lin, Choi Tae Young, Lee Hye Won, Lee Myeong Soo
Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon 34054, Korea.
Korean Convergence Medicine, University of Science and Technology, Daejeon 34113, Korea.
Pharmaceutics. 2021 Apr 1;13(4):476. doi: 10.3390/pharmaceutics13040476.
This review aimed to investigate the efficacy of integrative medicine (herbal medicine combined with drug therapy) in the treatment of Behcet's disease (BD). Eleven databases were searched from their inception to 7 December 2020, for randomized control trials (RCTs) that reported the effects of integrative medicine in treating BD. The risk of bias was assessed using seven domain criteria from the Cochrane Collaboration tool. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence. The direction of the effect is also shown in the form of an albatross plot. Sixteen trials met the inclusion criteria and were analyzed. The overall risk of bias was determined to be uncertain. The meta-analysis showed a superior response rate with herbal medicine plus drug therapy (relative risk (RR) 1.19, 95% confidence interval (CI) 1.13 to 1.25, = 1034, < 0.00001, I = 0%, low certainty of evidence (CoE)) compared to drug therapy. Integrative medicine also lowered the recurrence rate after 2 months of follow-up (RR 0.27, 95% CI 0.09 to 0.76, = 120, = 0.01, I = 0%, low CoE). The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and skin lesions were also significantly improved using integrative medicine, but equivalent effects were seen for oral ulcers, genital ulcers, and eye inflammation. Minor adverse events were reported in both groups. Our findings suggest that herbal medicine combined with drug therapy is more effective for the treatment of BD than drug therapy alone. Although the type of drug therapy used varied across the studies, integrative medicine was shown to improve the total response rate, skin lesions, the ESR, and the CRP level. However, the overall risk of bias of the studies was concerning, and the CoE was low. Information on adverse events (AEs) was also insufficient. In addition, the number of studies included for data synthesis for most outcomes was small. Future studies with rigorous RCTs may help establish the efficacy of integrative medicine in the treatment of BD.
本综述旨在研究中西医结合疗法（草药与药物治疗相结合）对白塞病（BD）的治疗效果。检索了11个数据库，时间跨度从建库至2020年12月7日，以查找报告中西医结合疗法治疗白塞病效果的随机对照试验（RCT）。使用Cochrane协作工具的七个领域标准评估偏倚风险。采用推荐分级评估、制定与评价（GRADE）方法评估证据质量。效应方向也以信天翁图的形式呈现。16项试验符合纳入标准并进行了分析。总体偏倚风险被判定为不确定。荟萃分析显示，与药物治疗相比，草药加药物治疗的总有效率更高（相对危险度（RR）为1.19，95%置信区间（CI）为1.13至1.25，n = 1034，P < 0.00001，I² = 0%，证据确定性低）。中西医结合疗法还降低了随访2个月后的复发率（RR为0.27，95%CI为0.09至0.76，n = 120，P = 0.01，I² = 0%，证据确定性低）。使用中西医结合疗法还显著改善了红细胞沉降率（ESR）、C反应蛋白（CRP）水平和皮肤病变，但口腔溃疡溃疡、生殖器溃疡和眼部炎症的效果相当。两组均报告了轻微不良事件。我们的研究结果表明，草药与药物治疗相结合对白塞病治疗比单纯药物治疗更有效。尽管各研究中使用的药物治疗类型不同，但中西医结合疗法显示出可提高总有效率、改善皮肤病变、ESR和CRP水平。然而，这些研究的总体偏倚风险令人担忧，证据确定性低。关于不良事件（AE）的信息也不足。此外，大多数结局数据合成纳入的研究数量较少。未来进行严格随机对照试验的研究可能有助于确定中西医结合疗法治疗白塞病的疗效。
