Efficacy and safety of seven Chinese patent medicines combined with conventional triple/quadruple therapy for Helicobacter pylori-positive peptic ulcers: a systematic review and network meta-analysis

• Published in: BMJ open Vol. 14; no. 4; p. e074188
• Main Authors: Jiang, Zhenyu, Deng, Boning, Zhang, Yaqi, Li, Ye, Yu, Zhijun, Deng, Haiying, Chen, Yajun
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 29.04.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Anti-Ulcer Agents - administration & dosage; Anti-Ulcer Agents - adverse effects; Anti-Ulcer Agents - therapeutic use; Antibiotics; Antigens; Bias; Chinese medicine; Cluster analysis; complementary medicine; Drug Therapy, Combination; Drugs, Chinese Herbal - adverse effects; Drugs, Chinese Herbal - therapeutic use; gastroduodenal disease; Gastroenterology and hepatology; Helicobacter Infections - drug therapy; Helicobacter pylori; herbal medicine; Humans; Infections; Intervention; Medical research; Meta-analysis; Network Meta-Analysis; Nonprescription Drugs - adverse effects; Nonprescription Drugs - therapeutic use; Peptic Ulcer - drug therapy; Peptic Ulcer - microbiology; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Randomized Controlled Trials as Topic; Software; Statistical analysis; Systematic review; Treatment Outcome; Ulcers; China; complementary medicine; gastroduodenal disease; systematic review; herbal medicine
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-074188

ObjectivesTo compare the efficacy and safety of seven Chinese patent medicines (CPMs) combined with conventional triple/quadruple therapy (T/Q) for Helicobacter pylori-positive peptic ulcers.DesignA systematic review and network meta-analysis.Data sourcesChina National Knowledge Infrastructure, VIP database, Wanfang database, ScienceDirect, EBSCO, EMBASE, Web of Science, Cochrane Library and PubMed were searched through 1 June 2022.Eligibility criteriaRandomised controlled trials (RCTs) testing CPMs combined with T/Q for H. pylori-positive peptic ulcers were included. The CPMs included Anweiyang capsule, Jianweiyuyang tablets/capsule/granule, Jinghuaweikang capsule, Kangfuxin liquid, Puyuanhewei capsule, Weifuchun tablets/capsule and Weisu granule. At least one of the following outcome indicators was recorded: complete ulcer healing rate (CUHR), effective rate (ER), H. pylori eradication rate (HPER), rate of peptic ulcer recurrence (RPUR) and incidence of adverse reactions (IAR).Data extraction and synthesisTwo researchers independently conducted the study selection and extracted data for included studies. The risk of bias was assessed using the Cochrane risk of bias tool. A pairwise meta-analysis was performed using RevMan V.5.3. Network meta-analysis was performed using STATA/MP V.15.0. Confidence in the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation.ResultsA total of 36 RCTs involving 3620 patients were included. Compared with T/Q alone, Weisu+T/Q, Weifuchun+T/Q and Puyuanhewei+T/Q had the highest CUHR, ER and HPER, respectively. Weisu+T/Q and Jianweiyuyang+T/Q had the lowest RPUR and IAR, respectively. The cluster analysis results showed Jianweiyuyang+T/Q might be the best choice concerning efficacy and safety simultaneously, followed by Kangfuxin+T/Q.ConclusionAmong the combination therapies with the CPMs, Jianweiyuyang+T/Q might be the most favourable option for H. pylori-positive peptic ulcers, followed by Kangfuxin+T/Q. Considering the limited quantity and quality of the included RCTs, the results should be interpreted with caution.PROSPERO registration numberCRD42022327687.