Abstract
Myasthenia gravis (MG) is an acquired autoimmune disease with the disorder of the neuromuscular junction transmission caused by autoantibodies. Currently, various Chinese herbal medicines (CHMs) are widely used for MG. This meta-analysis was conducted to assess the effectiveness and safety of CHMs for MG and its possible mechanisms. Fourteen studies with 1039 individuals were identified by searching seven databases from inception to March 2017. The methodological quality was assessed by using 7-item criteria from the Cochrane’s Collaboration tool, and which assessed ≥4 “yes” in the domains were selected for detailed assessment and meta-analysis. All the data were analyzed using Rev-Man 5.3 software. Meta-analysis showed a significant effect of CHM as adjuvant therapy for improving the effectiveness compared with WCM alone or placebo in treating MG (p < 0.01). Moreover, there were fewer adverse effects and relapse rate in total when compared with the control group. The possible mechanisms of CHM for MG are associated with immunoregulation by reconstituting the functional ability of Tregs. In conclusion, despite the apparent positive results, the present evidence supports, to an extent, that CHM can be used for MG patients because of the methodological flaws and CHM heterogeneity. Further rigorous RCT for MG is needed.
Highlights
Myasthenia gravis (MG) is an acquired autoimmune disorder of neuromuscular junction characterized by the easy fatigability and weakness of the skeletal muscles in which autoantibodies mostly directed to the acetylcholine receptor (AChR) and muscle-specific kinase (MuSK) (Gilhus and Verschuuren, 2015; Sanders et al, 2016) In addition, about 10–15% double-negative MG patients have antibodies against lipoprotein-related protein 4 (LRP4) (Li et al, 2018)
The evidence available from the present study is supported, at least to an extent, that CHMs paratherapy can be recommended for routine use for MG
High frequent uses of CHMs are selected to contribute to composing a herbal formula as a promising candidate for further clinical application and MG trials
Summary
Myasthenia gravis (MG) is an acquired autoimmune disorder of neuromuscular junction characterized by the easy fatigability and weakness of the skeletal muscles in which autoantibodies mostly directed to the acetylcholine receptor (AChR) and muscle-specific kinase (MuSK) (Gilhus and Verschuuren, 2015; Sanders et al, 2016) In addition, about 10–15% double-negative MG patients have antibodies against lipoprotein-related protein 4 (LRP4) (Li et al, 2018). A proportion of refractory MG patients usually presented with the debilitating weakness, frequent relapses, MuSK or LRP4 antibody positive, postthymectomy, and/or required high-dose steroids and add-on other IS agents (Drachman et al, 2008; Suh et al, 2013). The alternative strategy for MG or declining the side-effect of IS is urgently needed
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