Add-on effect of Chinese herbal medicine in the treatment of mild to moderate COVID-19: A systematic review and meta-analysis

Abstract

Introduction Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic since its outbreak in Wuhan, China. It is an urgent task to prevent and treat COVID-19 effectively early. In China’s experience combating the COVID-19 pandemic, Chinese herbal medicine (CHM) has played an indispensable role. A large number of epidemiological investigations have shown that mild to moderate COVID-19 accounts for the largest proportion of cases. It is of great importance to treat such COVID-19 cases, which can help control epidemic progression. Many trials have shown that CHM combined with conventional therapy in the treatment of mild to moderate COVID-19 was superior to conventional therapy alone. This review was designed to evaluate the add-on effect of CHM in the treatment of mild to moderate COVID-19. Methods Eight electronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, the Clinical Trials.gov website, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database and China Biology Medicine (CBM) were searched from December 2019 to March 2021 without language restrictions. Two reviewers searched and selected studies, and extracted data according to inclusion and exclusion criteria independently. Cochrane Risk of Bias (ROB) tool was used to assess the methodological quality of the included RCTs. Review Manager 5.3.0 software was used for statistical analysis. Results Twelve eligible RCTs including 1393 participants were included in this meta-analysis. Our meta-analyses found that lung CT parameters [RR = 1.26, 95% CI (1.15, 1.38), P<0.00001] and the clinical cure rate [RR = 1.26, 95%CI (1.16, 1.38), P<0.00001] of CHM combined with conventional therapy in the treatment of mild to moderate COVID-19 were better than those of conventional therapy. The rate of conversion to severe cases [RR = 0.48, 95%CI (0.32, 0.73), P = 0.0005], TCM symptom score of fever [MD = -0.62, 95%CI (-0.79, -0.45), P<0.00001], cough cases [RR = 1.43, 95%CI (1.16, 1.75), P = 0.0006], TCM symptom score of cough[MD = -1.07, 95%CI (-1.29, -0.85), P<0.00001], TCM symptom score of fatigue[MD = -0.66, 95%CI (-1.05, -0.28), P = 0.0007], and CRP[MD = -5.46, 95%CI (-8.19, -2.72), P<0.0001] of combination therapy was significantly lower than that of conventional therapy. The WBC count was significantly higher than that of conventional therapy[MD = 0.38, 95%CI (0.31, 0.44), P<0.00001]. Our meta-analysis results were robust through sensitivity analysis. Conclusion Chinese herbal medicine combined with conventional therapy may be effective and safe in the treatment of mild to moderate COVID-19. More high-quality RCTs are needed in the future.

Usefulness of herbal medicines in the prevention and management of coronavirus disease-2019 (COVID-19) and its symptoms: A review

“…Significant effects of the combined therapy of herbal medicine with Western medicine has been found, and this have revealed the potential role of herbal medicine in treating COVID-19 (Ang et al, 2020) [6] . In this regard, highquality clinical trials are needed to evaluate the efficacy and safety of herbal medicine or medicinal plants combined with conventional therapy in the treatment of adults with mild to moderate COVID-19 in the future (Du et al, 2021) [21] . Some, prelimentary studies hve been condiucted in some these plants, thus, some of them may acceptable preventive measure against COVID-19 infection to boost immune system cells and to repress the production and secretion of proinflammatory cytokines as well as an adipose tissue derived hormone leptin having the proinflammatory nature.…”

Herbal Medicine Intervention for the Treatment of COVID-19: A Living Systematic Review and Cumulative Meta-Analysis

“…To date, 21 systematic reviews have been identified that have similar findings to this current review ( Liu M. et al, 2020 ; Ang et al, 2020 ; Sun CY. et al, 2020 ; Xiong X. et al, 2020 ; Fan et al, 2020 ; Pang et al, 2020 ; Zeng et al, 2020 ; Zhou et al, 2020 ; Wang H. et al, 2021 ; Liu M. et al, 2021 ; Wang Q. et al, 2021 ; Du et al, 2021 ; Fan et al, 2021 ; Jiang et al, 2021 ; Li et al, 2021 ; Liang et al, 2021 ; Luo et al, 2021 ; Wu et al, 2021 ; Yan et al, 2021 ; Yin et al, 2021 ; Zhuang et al, 2021 ). The treatment of COVID-19 benefits from the rapid dissemination of evidence, providing data for the synthesizing of evidence disseminated was constantly complied by systematic reviewers, resulting in a large number of systematic reviews with overlapping evidence, each article updated with the inclusion of only one or two additional studies at the time of publication.…”

Nutraceuticals and COVID‐19: A mechanistic approach toward attenuating the disease complications

“…A clinical trial involving Nigella sativa supplement to investigate its efficacy in mild symptomatic COVID‐19 patients is ongoing (Koshak et al, 2020 ). A recent systematic review also highlighted those Chinese herbal medicines can be used in the treatment of mild to moderate COVID‐19 and they are very effective in the reduction of symptoms of fever and cough in COVID patients (Du et al, 2021 ). The illustration (Figure 1 ) shows the role of Nutraceuticals in the management of COVID‐19.…”