Cui Xin, Han Sheng, Jin Xiang-Lan, Wang Zhi-Fei, Zhang Qiang, Xie Yan-Ming
Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Beijing 100700, China.
International Research Center for Medicinal Administration, Peking University Beijing 100191, China.
Zhongguo Zhong Yao Za Zhi. 2021 Dec;46(23):6096-6104. doi: 10.19540/j.cnki.cjcmm.20210930.506.
This study systematically reviewed the existing research on Danhong Injection in the treatment of stroke with blood stasis syndrome. The methods of evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, drug economics, mathematical statistics, and health technology assessment(HTA) were employed to qualitatively and quantitatively evaluate the "6+1" dimensions(safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine) of Danhong Injection through questionnaire survey, public information, real world data, and secondary evaluation of literature. With the weights given by experts, the multi-criteria decision analysis(MCDA) model was employed to measure each dimension and highlight the clinical value of Danhong Injection. Multi-source safety evidence showed that Danhong Injection had been fully monitored and studied. The severity of adverse reactions was mostly moderate or mild, and the prognosis was good. So it was rated as grade A for safety. Compared with Ligustrazine Injection, Fufang Danshen Injection and conventional treatment of western medicine, Danhong Injection had obvious advantages in clinical response rate and NIHSS score improvement in the treatment of stroke with blood stasis syndrome. So it was rated as grade A for effectiveness. Compared with Ligustrazine Injection and Yinxing Damo Injection, Danhong Injection had a cost-effectiveness advantage in the treatment of stroke with blood stasis syndrome, and the economic results were good. According to the existing evidence, the Danhong Injection was rated as grade B for economy. Danhong Injection had won a number of national patents, which was rated as grade A for its good innovation in guaranteeing supply measures, scalability of production capacity, and production process. It had good suitability for clinicians, nurses, pharmacists, and patients using the drug, and met the needs of clinical medication, so it was rated as grade B for suitability. Danhong Injection is rich in medicinal materials, stable in price, and sustainable. However, its availability needed to be further improved due to the limitation of prescription use, so it was rated as grade B for accessibility. Danhong Injection can promote blood circulation, resolve blood stasis, warm vessels, and smooth collaterals. It had accumulated more than 30 000 pieces of empirical evidence for human use in the real world. It had prominent characteristics of traditional Chinese medicine and was rated as grade B. CSC v2.0 was used for calculation, and the clinical value of Danhong Injection was comprehensively evaluated as class A, which could be directly translated into relevant policy results of basic clinical medication management according to the Guidelines for the Management Clinical Comprehensive Evaluation of Drugs(trial version 2021).
本研究系统回顾了丹红注射液治疗血瘀证中风的现有研究。采用循证医学、流行病学、临床医学、循证药学、药物经济学、数理统计学和卫生技术评估(HTA)等方法,通过问卷调查、公开信息、真实世界数据以及文献二次评价,对丹红注射液的“6 + 1”维度(安全性、有效性、经济性、创新性、适用性、可及性和中医药特色)进行定性和定量评价。依据专家给出的权重,运用多准则决策分析(MCDA)模型对各维度进行衡量,突出丹红注射液的临床价值。多源安全性证据表明,丹红注射液已得到充分监测和研究。不良反应严重程度多为中度或轻度,预后良好,安全性评为A级。与川芎嗪注射液、复方丹参注射液及西医常规治疗相比,丹红注射液在治疗血瘀证中风时临床有效率及美国国立卫生研究院卒中量表(NIHSS)评分改善方面具有明显优势,有效性评为A级。与川芎嗪注射液和银杏达莫注射液相比,丹红注射液在治疗血瘀证中风时具有成本效益优势,经济结果良好,依据现有证据,经济性评为B级。丹红注射液获得多项国家专利,在保障供应措施、产能可扩展性和生产工艺方面创新良好,评为A级。它对使用该药物的临床医生、护士、药师和患者具有良好的适用性,满足临床用药需求,适用性评为B级。丹红注射液药材丰富、价格稳定且可持续,但由于处方使用限制,其可及性有待进一步提高,可及性评为B级。丹红注射液能活血化瘀、温通血管、疏通经络,在真实世界中积累了3万余条人体使用的经验证据,具有突出的中医药特色,评为B级。采用CSC v2.0进行计算,丹红注射液的临床价值综合评为A级,可依据《药物临床综合评价管理指南(试行版2021)》直接转化为基本临床用药管理的相关政策结果。