Chinese Herbal Medicine for Myasthenia Gravis: A Systematic Review and Meta-Analysis

Abstract

Myasthenia gravis (MG) is an acquired autoimmune disease with the disorder of the neuromuscular junction transmission caused by autoantibodies. Currently, various Chinese herbal medicines (CHMs) are widely used for MG. This meta-analysis was conducted to assess the effectiveness and safety of CHMs for MG and its possible mechanisms. Fourteen studies with 1039 individuals were identified by searching seven databases from inception to March 2017. The methodological quality was assessed by using 7-item criteria from the Cochrane’s Collaboration tool, and which assessed ≥4 “yes” in the domains were selected for detailed assessment and meta-analysis. All the data were analyzed using Rev-Man 5.3 software. Meta-analysis showed a significant effect of CHM as adjuvant therapy for improving the effectiveness compared with WCM alone or placebo in treating MG (p < 0.01). Moreover, there were fewer adverse effects and relapse rate in total when compared with the control group. The possible mechanisms of CHM for MG are associated with immunoregulation by reconstituting the functional ability of Tregs. In conclusion, despite the apparent positive results, the present evidence supports, to an extent, that CHM can be used for MG patients because of the methodological flaws and CHM heterogeneity. Further rigorous RCT for MG is needed.

Chinese herbal medicine for myasthenia gravis: A systematic review and meta-analysis of randomized clinical trials

“…The definition of “CHMs of the same category” was based on the treating principles of traditional Chinese medicine for MG. According to the previous study, spleen and kidney deficiency was the main pathogenesis of MG, and invigorating spleen and kidney was the treating principle for MG. 6 , 33 The most frequently used herb was Astragali Radix, 6 which was often used as the sovereign drug (main drug) in the prescription. The common minister drug (adjuvant drug) included Ginseng Radix et Rhizoma, Atractylodis Macrocephalae Rhizoma, Angelicae Sinensis Radix, Lycii Fructus 6 etc.…”

“…According to the previous study, spleen and kidney deficiency was the main pathogenesis of MG, and invigorating spleen and kidney was the treating principle for MG. 6 , 33 The most frequently used herb was Astragali Radix, 6 which was often used as the sovereign drug (main drug) in the prescription. The common minister drug (adjuvant drug) included Ginseng Radix et Rhizoma, Atractylodis Macrocephalae Rhizoma, Angelicae Sinensis Radix, Lycii Fructus 6 etc. If the sovereign drugs and the minister drugs were the same in the prescriptions studied in different RCTs, we considered these CHMs to be of the same category.…”

“…The possible mechanisms include promoting the expression of transcription factor Forkhead box protein P3 (FoxP3) to up-regulate T regulatory cells (Tregs), and decreasing cytokine expression such as IL- 4 and IL-13 (Astragalus membranaceus); increasing number of Tregs and inhibiting Th17 cell differentiation (Radix Ginseng); a decrease of autoantibodies and immunoglobulin G (IgG) (Bupleurum polysaccharides (BPs) from Radix Bupleuri) and anti-acetylcholinesterase effects (flavonoid derivatives from Buzhong Yiqi decoction). 6 A systematic review on CHM for MG was published in 2018, which included 14 randomized controlled trials (RCTs) published before 2017. 6 It concluded that CHM could be used for MG patients, but the conclusion was based on pooled data of different kinds of CHMs, the kind of CHM named HQFF (Compound Huangqi in English) was studied by three included RCTs, but the meta-analysis for this specific kind of CHM was not conducted.…”

“… 6 A systematic review on CHM for MG was published in 2018, which included 14 randomized controlled trials (RCTs) published before 2017. 6 It concluded that CHM could be used for MG patients, but the conclusion was based on pooled data of different kinds of CHMs, the kind of CHM named HQFF (Compound Huangqi in English) was studied by three included RCTs, but the meta-analysis for this specific kind of CHM was not conducted. Giving only the overall effect of all kinds of CHMs induced more clinical bias in the analysis and the certainty of evidence was not assessed.…”

Traditional Chinese medicine for myasthenia gravis

“…At present, TCM has been widely used for the treatment of MG due to its characteristics of low price, convenience, high efficacy, and few adverse reactions. [ 13 , 14 , 15 , 16 ] Now there are many traditional meta-analysis that some TCM methods do have a good effect on the treatment of MG, However, all of these are direct comparisons between a single TCM and Western medicine, and there are no studies that directly or indirectly compare different TCM. As we all know, there are many kinds of TCM treatment methods, and the treatment advantages are different, which causes confusion to the choice of clinical operators.…”