TY - JOUR
T1 - Modified Zhibai Dihuang pill, a traditional Chinese medicine formula, on steroid withdrawal in systemic lupus erythematosus
T2 - A systematic review and meta-analysis
AU - Dai, Liang
AU - Chan, Ka Kei
AU - Mao, Jian Chun
AU - Tian, Yu
AU - Gu, Jun Hua
AU - Zhou, Jun
AU - Zhong, Linda L.D.
N1 - Funding Information:
This study was supported by the Research Fund of Honours Project 2016–2017 of Bachelor of Chinese Medicine of Hong Kong Baptist University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher copyright:
© 2020 Shanghai Changhai Hospital. Published by ELSEVIER B.V. All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - BackgroundZhibai Dihuang pill (ZBDH), a Chinese herbal formula, has been widely used as an adjunctive therapy to help reduce the patient's steroid dose and maintain low disease activity in systemic lupus erythematosus (SLE). ObjectiveThis systematic review evaluates the therapeutic effect of modified ZBDH in reducing steroid use in patients with SLE. Search strategyA systematic literature search was carried out using seven databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese VIP Information and Wanfang Database, from their inception to June 1st, 2019. The search terms included “systemic lupus erythematosus,” “Chinese medicine” and “clinical trial,” and their synonyms. Subject headings matching the above terms were also used. Inclusion criteriaThis meta-analysis included randomized controlled trials that evaluated the reduction of steroid dose in patients with SLE. Traditional Chinese medicine (TCM) formulas in experimental group should be prescribed based on ZBDH and used as adjunctive therapy and the comparator should contain steroids. Data extraction and analysisTwo authors independently conducted database search, study selection, data extraction and quality assessment. The extracted information contained study design, sample size, recruitment mode, diagnostic criteria, inclusion and exclusion criteria, participant characteristics, TCM patterns, TCM formulas and treatment outcomes. The primary outcome was the change of steroid dose. Secondary outcomes included SLE Disease Activity Index (SLEDAI), biomarkers of disease activity and clinical response rate. STATA 15.0 was used to analyze the pooled effects reported as weighted mean difference (WMD) or odds ratio, with a 95% confidence interval (CI). ResultsIn total, 20 trials involving 1470 SLE patients were included. The pooled result showed that modified ZBDH taken in combination with standard care led to a larger reduction in steroid dose, compared to standard care alone (WMD: 3.79; 95% CI: 2.58–5.01; P < 0.001). Favorable outcomes were also seen in secondary outcome criteria, such as SLEDAI and complement 3. The modified ZBDH treatments were well tolerated without increasing adverse effects. ConclusionThe systematic review provided preliminary evidence supporting the use of ZBDH as a co-therapy to aid steroid dose reduction in patients with SLE. However, more rigorous studies should be conducted to validate these findings, and explore the mechanisms of ZBDH's relevant bioactive constituents.
AB - BackgroundZhibai Dihuang pill (ZBDH), a Chinese herbal formula, has been widely used as an adjunctive therapy to help reduce the patient's steroid dose and maintain low disease activity in systemic lupus erythematosus (SLE). ObjectiveThis systematic review evaluates the therapeutic effect of modified ZBDH in reducing steroid use in patients with SLE. Search strategyA systematic literature search was carried out using seven databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese VIP Information and Wanfang Database, from their inception to June 1st, 2019. The search terms included “systemic lupus erythematosus,” “Chinese medicine” and “clinical trial,” and their synonyms. Subject headings matching the above terms were also used. Inclusion criteriaThis meta-analysis included randomized controlled trials that evaluated the reduction of steroid dose in patients with SLE. Traditional Chinese medicine (TCM) formulas in experimental group should be prescribed based on ZBDH and used as adjunctive therapy and the comparator should contain steroids. Data extraction and analysisTwo authors independently conducted database search, study selection, data extraction and quality assessment. The extracted information contained study design, sample size, recruitment mode, diagnostic criteria, inclusion and exclusion criteria, participant characteristics, TCM patterns, TCM formulas and treatment outcomes. The primary outcome was the change of steroid dose. Secondary outcomes included SLE Disease Activity Index (SLEDAI), biomarkers of disease activity and clinical response rate. STATA 15.0 was used to analyze the pooled effects reported as weighted mean difference (WMD) or odds ratio, with a 95% confidence interval (CI). ResultsIn total, 20 trials involving 1470 SLE patients were included. The pooled result showed that modified ZBDH taken in combination with standard care led to a larger reduction in steroid dose, compared to standard care alone (WMD: 3.79; 95% CI: 2.58–5.01; P < 0.001). Favorable outcomes were also seen in secondary outcome criteria, such as SLEDAI and complement 3. The modified ZBDH treatments were well tolerated without increasing adverse effects. ConclusionThe systematic review provided preliminary evidence supporting the use of ZBDH as a co-therapy to aid steroid dose reduction in patients with SLE. However, more rigorous studies should be conducted to validate these findings, and explore the mechanisms of ZBDH's relevant bioactive constituents.
KW - Meta-analysis
KW - Steroid
KW - Systematic review
KW - Systemic lupus erythematosus
KW - Traditional Chinese medicine
UR - http://www.scopus.com/inward/record.url?scp=85090302581&partnerID=8YFLogxK
U2 - 10.1016/j.joim.2020.08.007
DO - 10.1016/j.joim.2020.08.007
M3 - Review article
C2 - 32907784
AN - SCOPUS:85090302581
SN - 2095-4964
VL - 18
SP - 478
EP - 491
JO - Journal of integrative medicine
JF - Journal of integrative medicine
IS - 6
ER -