Abstract
BackgroundCellular immune responses including lymphocyte functions and immune effector cells are critical for the control of coronavirus infection. Chinese herbal medicine (CHM) potentially has a therapeutic effect for treatment of coronavirus disease 2019 (COVID-19). Nevertheless, there are limited clinical practice suggestions on immunogenicity of the CHM against SARS-CoV-2. To assess the effect of oral CHM on immunogenicity and whether oral CHM improves the clinical parameters through the immunity profile during COVID-19, we performed the present study.MethodsFor this systematic review and meta-analysis, 11 databases were searched for relevant studies assessing oral CHM for COVID-19 on November 20, 2020 (updated March 9, 2021). Primary outcomes mainly included immunity profiles. Secondary outcomes included all-cause mortality; the remission time of fever, cough, chest tightness, and fatigue. The random effect was used to estimate the heterogeneity of the studies. Summary relative risks, weight mean difference and standardized mean difference were measured with 95% confidence intervals. Modified Jadad scale and Newcastle-Ottawa Scale were used to assess the risk of bias of randomized controlled trials (RCTs) and observational studies, respectively. The certainty of evidence was evaluated using the GRADE approach.ResultsWe analyzed findings from 3,145 patients in 30 eligible studies. Compared with routine treatment, oral CHM, as an adjuvant medicine, improved lymphocyte counts, CD4+, and CD4+/CD8+ ratio with low quality of evidence; improved CD3+ with moderate quality of evidence; and reduced TNF-α with low certainty of evidence. Besides, oral CHM, as an adjuvant medicine reduced the time to clinical symptoms remission with a lower risk of all-cause mortality, compared with routine treatment alone.ConclusionCHM may be recommended as an adjuvant immunotherapy for disease modification and symptom relief in COVID-19 treatment. However, large RCTs objectively assessing the efficacy of CHM on immune responses in COVID-19 are needed to confirm our findings.
Highlights
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), contributed to the collapse of the immune system and has become a devastating pandemic with substantial mortality [1, 2]
Some work has been aimed at elucidating the improvement in CT scan, reverse transcriptase-polymerase chain reaction (RT-PCR) negativity rate, as well as the lower rate of adverse effects of COVID-19 patients treated with Chinese herbal medicine (CHM), compared with routine treatment based on western medicine [14], there are limited clinical practice suggestions on the immunogenicity of oral CHM against SARS-CoV-2
The combined weight mean difference (WMD) of lymphocyte count showed significant increase on lymphocyte count in CHM arm [WMD 0.37; P = 0.002; I2 = 98 %]
Summary
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), contributed to the collapse of the immune system and has become a devastating pandemic with substantial mortality [1, 2]. Cellular immune responses consisting of CD3+ T, CD4+ T, and CD8+ T cells response underlying immunopathogenesis in COVID-19, which are critical for the control of coronavirus infection [1, 3]. There are limited data on the associated immunological profile and the clinical parameters in COVID-19 treatment. Cellular immune responses including lymphocyte functions and immune effector cells are critical for the control of coronavirus infection. Chinese herbal medicine (CHM) potentially has a therapeutic effect for treatment of coronavirus disease 2019 (COVID-19). There are limited clinical practice suggestions on immunogenicity of the CHM against SARS-CoV-2. To assess the effect of oral CHM on immunogenicity and whether oral CHM improves the clinical parameters through the immunity profile during COVID-19, we performed the present study
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