Comparative Effectiveness and Safety of Seven Qi-Tonifying Chinese Medicine Injections for AECOPD Patients: A Systematic Review and Network Meta-Analysis.

Xueyi Deng,Fuqin Kang,Xinfeng Guo,Xueyin Chen,Jiaqi Lai,Xuanchen Guan,Shaonan Liu,Longfei Yang

doi:10.1155/2021/6517515

Abstract

Introduction Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) imposes a large burden on economy and society worldwide. In addition to western medicine, multiple kinds of qi-tonifying Chinese medicine injections have been widely used in China as adjunctive treatments. Previous small-sample clinical trials have proven their efficacy in the treatment of AECOPD. However, data on comparative effectiveness and safety of qi-tonifying injections are limited. We conducted this network meta-analysis to compare the efficacy and safety of 7 commonly used qi-tonifying injections in patients with AECOPD. Methods Literature search was conducted through electronic databases, including PubMed, the Cochrane Library, EMBASE, CINAHL, AMED, CBM, CNKI, Wanfang database, and VIP database. Randomized clinical trials (RCTs) exploring the efficacy of any of these 7 qi-tonifying injections were included. The primary outcome was lung function (FEV1 and FVC). R 4.0.0 and STATA 12.0 were adopted to perform the network meta-analysis using Bayesian statistics. Results A total of 36 RCTs involving 2657 participants were included. The results of network meta-analyses indicated that Chuankezhi injection (CKZ) combined with routine treatment (RT) was superior to other qi-tonifying injections combined with RT in terms of FEV1 improvement (MD = 0.63, 95% CI: 0.22, 1.04). For improving FVC, Shengmai injection (SGM) combined with RT showed the greatest therapeutic effect (MD = 0.38, 95% CI: 0.13, 0.61). Moreover, SGM combined with RT revealed the best estimates for response rate (MD = 4.00, 95% CI: 1.34, 13.63). The main adverse events in this study were gastrointestinal reactions and injection site reactions. No serious adverse events were reported. Conclusion In this network meta-analysis, SGM and CKZ were potential best adjunctive therapies in the treatment of AECOPD.

Highlights

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) imposes a large burden on economy and society worldwide
In comparison between 7 qitonifying injections combined with routine treatment (RT), respectively, Shenmai injection (SM) (MD 0.34, 95% CI: 0.22, 0.46), Huangqi injection (HQ) (MD 0.25, 95% CI: 0.23, 0.27), Shenqi Fuzheng injection (SQFZ) (MD 0.26, 95% CI: 0.09, 0.42), and Shengmai injection (SGM) (MD 0.39, 95% CI: 0.29, 0.49) combined with RT showed significant effect in FEV1
Chuankezhi injection (CKZ) + RT (MD 0.62, 95% CI: 0.53, 0.72), SQFZ + RT (MD 0.20, 95% CI: 0.03, 0.37), and SGM + RT (MD 0.39, 95% CI: 0.26, 0.51) achieved better FVC compared with RT

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is defined by persistent respiratory symptoms and airflow limitation which is due to airway and/or alveolar abnormalities [1]. Routine western medicine for AECOPD mainly includes bronchodilators, corticosteroids, antibiotics, and supplemental oxygen for emergency [1] Owing to their clinical benefits in relieving symptoms, these therapies are widely used. In order to provide the best available treatment, a network metaanalysis was conducted to compare the efficacy and safety of 7 commonly used qi-tonifying injections in patients with AECOPD. We included published RCTs that met the following criteria: (1) trials that enrolled patients with definite diagnostic criteria of AECOPD; (2) trials that explored the efficacy of any of these 7 qi-tonifying injections; (3) qi-tonifying injections were given as intravenous except CKZ, whose conventional usage is intramuscular injection; and (4) trials that reported at least one of the following outcomes: the primary outcome was lung function (including FEV1、FVC); secondary outcomes were FEV1%, arterial blood gas analysis (including PaO2 and PaCO2), response rate, the six-minute walking distance (6MWD), the length of hospitalization, and modified British medical research council (mMRC). Funnel plots and Egger’s test were conducted to assess the publication bias

Results

Discussion

Conclusions

Conflicts of Interest