Comparative Effectiveness and Safety of Seven Qi-Tonifying Chinese Medicine Injections for AECOPD Patients: A Systematic Review and Network Meta-Analysis

Abstract

Introduction. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) imposes a large burden on economy and society worldwide. In addition to western medicine, multiple kinds of qi-tonifying Chinese medicine injections have been widely used in China as adjunctive treatments. Previous small-sample clinical trials have proven their efficacy in the treatment of AECOPD. However, data on comparative effectiveness and safety of qi-tonifying injections are limited. We conducted this network meta-analysis to compare the efficacy and safety of 7 commonly used qi-tonifying injections in patients with AECOPD. Methods. Literature search was conducted through electronic databases, including PubMed, the Cochrane Library, EMBASE, CINAHL, AMED, CBM, CNKI, Wanfang database, and VIP database. Randomized clinical trials (RCTs) exploring the efficacy of any of these 7 qi-tonifying injections were included. The primary outcome was lung function (FEV1 and FVC). R 4.0.0 and STATA 12.0 were adopted to perform the network meta-analysis using Bayesian statistics. Results. A total of 36 RCTs involving 2657 participants were included. The results of network meta-analyses indicated that Chuankezhi injection (CKZ) combined with routine treatment (RT) was superior to other qi-tonifying injections combined with RT in terms of FEV1 improvement (MD = 0.63, 95% CI: 0.22, 1.04). For improving FVC, Shengmai injection (SGM) combined with RT showed the greatest therapeutic effect (MD = 0.38, 95% CI: 0.13, 0.61). Moreover, SGM combined with RT revealed the best estimates for response rate (MD = 4.00, 95% CI: 1.34, 13.63). The main adverse events in this study were gastrointestinal reactions and injection site reactions. No serious adverse events were reported. Conclusion. In this network meta-analysis, SGM and CKZ were potential best adjunctive therapies in the treatment of AECOPD.

The Efficacy and Safety of Xinjia Xuanbai Chengqi Granules in Acute Exacerbation of COPD: A Multicentre, Randomised, Double-Blind, Controlled Trial

“…As the study protocol reported [14], AECOPD patients of clinical-grade severity of I-II [1,15] with a syndrome of heat-phlegm and sthenic-fu, in the age range from 40 to 80 years, who volunteered to participate in the study and signed the informed consent were included in this trial. Meanwhile, patients who met any of the following criteria were excluded: (1) patients complicated with asthma, pneumonia, bronchiectasis, cystic fibrosis, pulmonary tuberculosis, lung cancer, or any other airflow-limiting disease with known causes and characteristic pathology; (2) patients complicated with coronary heart disease, hypertensive heart disease, or heart valve disease; (3) patients needing invasive mechanical ventilation; (4) patients with clinically confirmed or highly suspected pulmonary embolism; (5) patients with severe diseases of cardiovascular, cerebrovascular, hepatorenal, haematopoietic, or endocrine system; (6) patients with intestinal obstruction requiring surgical intervention; (7) pregnant or lactating patients; (8) mentally handicapped patients; (9) patients with alanine aminotransferase (ALT) and aspartate aminotransferase (AST) >1.5 times the upper limit of normal reference or serum creatinine (Scr) above the upper limit of normal reference; (10) patients requiring immunosuppressants; (11) patients taking oral or intravenous antibiotics before screening for more than 3 days in the last 3 months; (12) patients allergic to the basic therapeutic drugs, Chinese herbal medicinal ingredient prescription, or other substances prescribed through the research; (14) patients who have participated in or are participating in other clinical trials in the last 3 months; and (15) patients who were considered inappropriate to participate in this clinical trial by the investigator.…”

“…Discussion. Patients with chronic respiratory disease are two to three times more likely to have gastrointestinal issues, and COPD patients have had higher incidences of inflammatory bowel disease (IBD) compared to non-COPD controls, while over a half of IBD patients, in contrast, show pulmonary involvement [9,10]. Of COPD patients, 40% have had irregular stools compared to 15% of non-COPD patients when hospitalised, showing statistical difference [16].…”

“…Complementary treatment, whose efficacy was confirmed by many studies, has been widely used in many chronic diseases as an alternative therapy to conventional medicines [8][9][10][11]. Traditional Chinese medicine (TCM), characterised by the theory of syndrome differentiation and overall conditioning, implies its potential advantages in the treatment of COPD.…”

Scientific Evidence of Traditional Chinese Exercise (Qigong) for Chronic Obstructive Pulmonary Disease: An Overview of Systematic Reviews and Meta-Analyses

“…In addition, COPD-related mortality is expected to increase gradually due to increased environmental exposures (smoking, ambient particulate matter, etc.) and an aging population [ 4 ]. By 2060, more than 5.4 million people could die each year from COPD and related diseases [ 1 ].…”