Chinese Herbal Medicine Xingnaojing Injection for Acute Ischemic Stroke: An Overview of Systematic Reviews and Meta-Analyses

Abstract

Background: Xingnaojing injection (XNJ) is the only Chinese herbal injection approved for both intracerebral hemorrhage and ischemic stroke (IS) first-aid on ambulances in China; many systematic reviews (SRs) and meta-analyses (MAs) of XNJ on stroke have been published. The purpose of this research was to evaluate and summarize the current evidence on XNJ for IS.Methods: A comprehensive search was conducted for SRs and MAs of XNJ on IS in seven databases up to January 1, 2021. Two authors independently identified SRs and MAs, extracted data, assessed the quality of the included SRs and MAs using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), and assessed quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).Results: A total of 10 SRs met the inclusion criteria. The quality of included SRs using AMSTAR 2 was critically low as the critical items were poorly reported. Only 10% of SRs reported 50% of the 16 items, while the remaining 90% SRs reported just less than half of the items on AMSTAR 2. For GRADE, 7 (35%) of outcomes had low-quality evidence, 10 (50%) with very low, and 3 (15%) with moderate quality evidence. Very low to low quality of evidence indicated XNJ plus conventional therapy (CT) alleviated the neurological deficits of acute IS. Moderate-quality evidence showed XNJ plus CT reduced mortality when compared to Danshen injection plus CT, and very low-quality evidence showed XNJ plus CT could not improve the degree of coma, while low-quality evidence indicated the opposite. Mild adverse events in the CT group were less than those in the XNJ plus CT group, and there were no serious adverse events, but there was no statistical difference between the two groups. The included 10 SRs indicated that XNJ was used for acute IS, but only four SRs (40%) reported the course of disease.Conclusion: XNJ appears to be effective and safe for acute IS in improving the neurological deficits, but the evidence is not robust enough. However, whether administering XNJ immediately after or within 24 h of IS is best remains unknown due to the lack of data. Well-designed large-scale randomized controlled trials with measurable outcomes are required in future studies.

Pharmacology, Toxicology, and Rational Application of Cinnabar, Realgar, and Their Formulations

“…Xingnaojing injection (XNJ) is the only Chinese herbal injection approved for emergency treatment of stroke in China [ 130 ]. In the treatment of ischemic stroke, XNJ results in a significantly better overall response rate and better improvement of clinical symptoms than conventional treatment alone [ 130 , 131 ].…”

“…Xingnaojing injection (XNJ) is the only Chinese herbal injection approved for emergency treatment of stroke in China [ 130 ]. In the treatment of ischemic stroke, XNJ results in a significantly better overall response rate and better improvement of clinical symptoms than conventional treatment alone [ 130 , 131 ]. In addition, XNJ can be used alone or as an adjuvant therapy to reduce brain damage and improve nerve health for the treatment of acute cerebral hemorrhage [ 132 ] and traumatic craniocerebral injury [ 133 , 134 ].…”

Efficacy and Safety of Xingnaojing Injection for Emergency Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

“…Continued evaluation of clinical efficacy from meta-analyses indicates that XNJ can benefit patients with ischemic stroke ( Peng et al, 2014 ; Ma et al, 2017 ; Tian et al, 2021 ). A previous systematic review ( Peng et al, 2014 ) of thirteen trials published in 2014 suggested that the efficacy and safety of XNJ in stroke patients were inconclusive, and it lacked subgroup analysis according to the types of strokes.…”

“…It was uncertain whether XNJ can be used immediately after the symptom onset. An overview of systematic reviews ( Tian et al, 2021 ) pointed out that previous systematic reviews of XNJ for ischemic stroke had the following problems: 1) some critical items of AMSTAR2 were poorly reported, which included predefined protocol, comprehensive search strategy, list of excluded studies, and reasons for exclusion. 2) Primary outcomes have always been measured using the total effective rate and neurological function instead of the modified Rankin Scale (mRS).…”

Trial of a prehospital intervention with traditional Chinese medicine for acute stroke (TRACE): Protocol for a mixed-methods research study

“…However, on conducting an overview of systematic reviews and meta-analyses ( Tian et al, 2021 ), we found that none of the included studies reported on the different medication timings of XNJI use in acute stroke and on stroke severity. We also conducted a mixed-methods research (MMR) study ( Tian, 2021 ) and found that early XNJI use within 6 h of stroke onset maybe associated with greater functional improvement. However, the appropriate initiation time of XNJI treatment is also unclear due to medical insurance restrictions and concerns regarding possible incompatibility between XNJI and IVT.…”