Efficacy of Chinese Herbal Injections for the Treatment of Primary Nephrotic Syndrome: A Bayesian Network Meta-Analysis of Randomized Controlled Trials.

Hangxing Yu,Ming Pei,Wei Lin,Kang Yang,Lin Wang,Miaoru Han,Panying Liu,Hongtao Yang

doi:10.3389/fphar.2020.579241

Abstract

BackgroundConsidering the adverse reactions and side effects of immunosuppressive and cytotoxic drugs for the treatment of Primary Nephrotic Syndrome (PNS) and the extensive exploration of Chinese herbal injections (CHIs), systematic evaluation of the efficacy of different CHIs in the treatment of PNS is a key imperative. In this study, we performed a network meta-analysis to investigate the efficacy of CHIs in the treatment of PNS.MethodsA systematic literature review including studies published from the establishment of each database to May 28, 2020, was conducted in PubMed, the Cochrane Library, Embase, Web of Science, the Chinese Biological Medicine Literature Service System (CBM), the China National Knowledge Infrastructure (CNKI) database, the Chinese Scientific Journal Database (VIP), and the Wanfang Database (WF).Two evaluators independently screened the literature, extracted data and the Cochrane Reviewer’s Handbook 5.1 method was used to evaluate the quality of included studies. The differences in efficacy of different CHIs were compared and ranked using Stata 16.0 software. Surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the examined treatments. Clustering analysis was performed to compare the effects of CHIs between two different outcomes.ResultsA total of 41 eligible randomized controlled trials involving 2879 patients and nine CHIs were included. Nine CHIs were Xiangdan injection (XDI), Huangqi injection (HQI), Shenkang injection (SKI), Danshen injection (DSI), Yinxingdamo injection (YXI), Dengzhanhuasu injection (DZI), Danhong injection (DHI), Shuxuetong injection (SXI), Chuanxiongqin injection (CXI). The results of the network meta-analysis showed that: with Western medical (WM) treatment as a co-intervention, in terms of improving the total clinical effectiveness and serum albumin level, DHI was the most likely to be the best choice for treatment (SUCRA = 82.2%); YXI had the highest probability of being the best option in terms of reducing 24-h urinary protein excretion (SUCRA = 97.8%); in cholesterol-lowering comparisons, the SUCRA value allows for the most likely to be the best treatment is DZI (SUCRA = 84.5%). SXI was the most effective CHIs in terms of lowering serum triglycerides (SUCRA = 85.6%), whereas on the reducing fibrinogen side, the efficacy of CXI was significant (SUCRA = 67.6%). The result cluster analysis indicated that YXI and DHI were the best interventions with respect to total clinical effectiveness, 24-h urinary protein excretion and serum albumin.ConclusionsCHIs were found to be superior to WM alone in the treatment of PNS and may be beneficial for patients with PNS. WM+YXI and WM+DHI had the potential to be the best CHI with respect to the total clinical effectiveness, 24-h urinary protein excretion and serum albumin. However, more well-designed randomized controlled trials are still warranted.

Highlights

Nephrotic syndrome (NS) is the pathologic condition of large amount of proteinuria (> 3.5 g/d), hypoalbuminemia (< 30 g/L), edema and/or hyperlipidemia caused by the loss of plasma protein in the urine due to the damage of the basement membrane of the glomerulus and the failure of the glomerular filtration barrier
Network meta-analysis results indicated that all 9 types of Chinese medicine injections (CHIs) each significantly improved CR rate in primary nephrotic syndrome (PNS) patients compared to western medicine (WM) alone, except for the groups receiving WM+Xiangdan injection (XDI) (OR = 0.94,95%CI [0.39,2.24]) or WM+ DZI (OR = 0.42, 95% CI [0.13,1.36])
WM +XDI was significantly inferior to WM + HQI (OR = 1.03,95% CI [0.03,2.04]), WM + DSI (OR = 0.18,95% CI [0.04,0.83]), WM + YXI (OR = 0.30, 95% CI [0.11, 0.81]), WM+DHI (OR = 0.21,95% CI [0.07,0.61]), and WM + CXI (OR = 0.76,95% CI [0.09,1.43]) in increasing total clinical effectiveness (Table 2)

Summary

Introduction

Nephrotic syndrome (NS) is the pathologic condition of large amount of proteinuria (> 3.5 g/d), hypoalbuminemia (< 30 g/L), edema and/or hyperlipidemia caused by the loss of plasma protein in the urine due to the damage of the basement membrane of the glomerulus and the failure of the glomerular filtration barrier. CHIs are sterile preparations made from chinese herbal medicines after extraction and purification for input into the human body, which is a combination of traditional medicine theory and modern medicine It has the advantages of high bioavailability and fast onset of action, and has widely used in clinical applications, but there are more varieties available in CHIs. Differences in clinical efficacy and safety are unclear, creating confusion for patients and physicians. Considering the adverse reactions and side effects of immunosuppressive and cytotoxic drugs for the treatment of Primary Nephrotic Syndrome (PNS) and the extensive exploration of Chinese herbal injections (CHIs), systematic evaluation of the efficacy of different CHIs in the treatment of PNS is a key imperative. We performed a network meta-analysis to investigate the efficacy of CHIs in the treatment of PNS

Methods

Results

Discussion

Conclusion