Li Huimin, Hu Ruixue, Xu Simin, Dai Zeqi, Wu Xue, Hu Jing, Liao Xing
Centre for Evidence-Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.
Department of Clinical Epidemiology, Beijing Traditional Chinese Medicine Hospital, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China.
Evid Based Complement Alternat Med. 2022 Apr 12;2022:3151936. doi: 10.1155/2022/3151936. eCollection 2022.
To summarize the quantity and quality of evidence for using (TwHF) preparations in patients with rheumatoid arthritis (RA) and to find the reasons of the disparity by comprehensively appraising the related systematic reviews (SRs).
We performed an overview of evidence for the effectiveness and safety of TwHF preparations for patients with RA. We searched seven literature databases from inception to July 15, 2021. We included SRs of TwHF preparations in the treatment of RA. Four tools were used to evaluate the reporting quality, methodological quality, risk of bias, and the certainty of evidence for the included SRs, which are the PRISMA, the AMSTAR-2, the ROBIS, and the GRADE approach.
We included 27 SRs (with 385 studies and 33,888 participants) for this overview. The AMSTAR-2 showed that 19 SRs had critically low methodological quality and the remaining 8 had low methodological quality. The rate of overlaps was 68.31% (263/385), and the CCA (corrected covered area) was 0.53, which indicated the degree of overlap is slight. Based on the assessment of ROBIS, all 27 SRs were rated as low risk in phase 1; one SR was rated as low risk in domain 1, 9 SRs were in low risk in domain 2, 16 SRs were in low risk in domain 3, and 16 SRs were in low risk in domain 4 in phase 2; 7 SRs were rated as low risk in phase 3. Among 27 items of PRISMA, 15 items were reported over 70% of compliance, the reporting quality of 16 SRs was rated as "fair," and 11 were "good." Using GRADE assessment, moderate quality of evidence was found in 5 outcomes, and 5 outcomes were low quality.
The use of TwHF preparations for the treatment of RA may be clinically effective according to the moderate-quality evidence. There are methodological issues, risk of bias, and reporting deficiencies still needed to be improved. SRs with good quality and further randomized clinical trials that focus on clinical important outcomes are needed.
通过全面评估相关系统评价（SRs），总结类风湿关节炎（RA）患者使用雷公藤多苷（TwHF）制剂的证据数量和质量，并找出差异的原因。
我们对TwHF制剂治疗RA患者的有效性和安全性证据进行了概述。我们检索了从数据库建立到2021年7月15日的七个文献数据库。我们纳入了TwHF制剂治疗RA的SRs。使用四种工具来评估纳入SRs的报告质量、方法学质量、偏倚风险和证据确定性，这四种工具分别是PRISMA、AMSTAR - 2、ROBIS和GRADE方法。
我们纳入了27篇SRs（涉及385项研究和33888名参与者）进行本次概述。AMSTAR - 2显示，1`9篇SRs的方法学质量极低，其余8篇方法学质量低。重叠率为68.31%（263/385），校正覆盖面积（CCA）为0.53，表明重叠程度轻微。基于ROBIS评估，所有27篇SRs在第1阶段被评为低风险；在第2阶段，1篇SRs在领域1被评为低风险（LR），9篇在领域2为LR，16篇在领域3为LR，16篇在领域4为LR；7篇SRs在第3阶段被评为LR。在PRISMA的27项中，15项报告的合规率超过70%，16篇SRs的报告质量被评为“中等”，11篇为“良好”。使用GRADE评估，5个结局发现证据质量为中等，5个结局为低质量。
根据中等质量的证据，使用TwHF制剂治疗RA可能在临床上有效。仍存在方法学问题、偏倚风险和报告缺陷需要改进。需要高质量的SRs和关注临床重要结局的进一步随机临床试验。
