Zhang Qiang, Wang Zhi-Fei, Xie Yan-Ming, Liu Huan, Cui Xin, Lyu Jian
Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Beijing 100700, China.
Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Beijing 100700, China Xiyuan Hospital, China Academy of Chinese Medical Sciences Beijing 100091, China.
Zhongguo Zhong Yao Za Zhi. 2022 Mar;47(6):1459-1468. doi: 10.19540/j.cnki.cjcmm.20211123.501.
The present study systematically sorted out the existing research on Qilong Capsules in the treatment of ischemic stroke with Qi deficiency and blood stasis syndrome and comprehensively evaluated its clinical evidence and value to highlight the advantages and characteristics of products and provide references for the decision-making of national pharmaceutical management departments. Based on the evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, and pharmacoeconomics, the qualitative and quantitative evaluation of "6+1" dimensions of safety, effectiveness, economy, innovation, suitability, and accessibility, as well as characteristics of traditional Chinese medicine(TCM) was performed with multi-criteria decision analysis(MCDA) mo-del using the information, such as public data, literature data, pharmaceutical research, and questionnaire survey, and CSC v2.0 was used to calculate the clinical value of Qilong Capsules. The evaluation results were grade A, B, C, or D. Spontaneous reporting system(SRS) monitoring data, literature reports, clinical trials, and other multi-source safety evidence showed that the main adverse reactions of this drug included dry mouth, nausea, and rash, and no severe adverse reactions was found. The evidence was sufficient with small and controllable known risks, and the safety was grade A. Meta-analysis showed that Qilong Capsules combined with conventional western medicine in the treatment of acute ischemic stroke was superior to the control group in improving neurological deficits, clinical total response rate, patients' activities of daily living, and hemorheological indexes. The level of evidence was high with manifest clinical significance, and the effectiveness was grade A. The results of pharmacoeconomic research showed that Qilong Capsules combined with conventional western medicine in the treatment of ischemic stroke were advantageous in cost-effectiveness as compared with conventional western medicine alone, but the incremental effect was not significant. The quality evaluation results of the economic report were comparatively clear, and the economy was grade B. Aiming at major cerebrovascular diseases in the society and giving full play to the advantages of TCM, Qilong Capsules focused on the inheritance of classics and scientific and technological innovation, and innovation was grade B. The results of the questionnaire survey showed that the technical characteristics and drug application could meet the medication needs of clinical doctors and patients, and the suitability was grade B. The price level of this drug was comparatively high and the affordability was good since the treatment cost accounted for a small proportion of disposable income. The drug accessibility was good with a wide range of drug sales, sufficient production capacity, and sustainable medicinal materials resources, and was grade B. This drug was derived from the classic prescription Buyang Huanwu Decoction with rich experience of human application, which could regulate Qi and blood circulation, and the section of TCM characteristics was grade B. Based on the evidence evaluation results of "6+1" dimensions of Qilong Capsules, the comprehensive evaluation of clinical value was class A. It is suggested that it can be transformed into relevant policy results of basic clinical medication management according to procedures.
本研究系统梳理了芪龙胶囊治疗气虚血瘀型缺血性脑卒中的现有研究,综合评价其临床证据和价值,以突出产品优势和特点,为国家药品管理部门决策提供参考。基于循证医学、流行病学、临床医学、循证药学和药物经济学,运用多准则决策分析(MCDA)模型,采用公共数据、文献数据、药学研究、问卷调查等信息,对芪龙胶囊安全性、有效性、经济性、创新性、适用性、可及性“6 + 1”维度以及中医药特色进行定性和定量评价,并使用CSC v2.0计算芪龙胶囊的临床价值。评价结果分为A、B、C、D四级。自发报告系统(SRS)监测数据、文献报道、临床试验等多源安全性证据显示,该药物主要不良反应包括口干、恶心、皮疹,未发现严重不良反应。证据充分,已知风险小且可控,安全性为A级。Meta分析表明,芪龙胶囊联合西药治疗急性缺血性脑卒中在改善神经功能缺损、临床总有效率、患者日常生活活动能力及血液流变学指标方面优于对照组。证据级别高,临床意义明显,有效性为A级。药物经济学研究结果显示,芪龙胶囊联合西药治疗缺血性脑卒中与单纯西药相比具有成本效果优势,但增量效果不显著。经济报告质量评价结果较为明确,经济性为B级。针对社会重大脑血管疾病,充分发挥中医药优势,芪龙胶囊注重经典传承和科技创新,创新性为B级。问卷调查结果显示,其技术特性和药物应用能够满足临床医生和患者用药需求,适用性为B级。该药物价格水平相对较高,但治疗费用占可支配收入比例小,可承受性良好,药物可及性良好,药品销售范围广,生产能力充足,药材资源可持续,可及性为B级。该药物源自经典方剂补阳还五汤,有丰富的人体应用经验,可理气活血,中医药特色部分为B级。基于芪龙胶囊“6 + 1”维度的证据评价结果,临床价值综合评价为A级。建议可按程序转化为基础临床用药管理的相关政策成果。