Efficacy and Safety of NaoShuanTong Capsule in the Treatment of Ischemic Stroke: A Meta-Analysis

Abstract

Background: Ischemic stroke (IS) is a leading cause of death and long-term disability worldwide. The NaoShuanTong capsule (NSTC), a traditional Chinese patent medicine, has been extensively used in the treatment of stroke in China. However, the clinical efficacy and safety of this treatment has not been statistically and systematically verified by any comprehensive pooled analysis. We therefore performed a meta-analysis to evaluate the efficacy and safety of NSTC in the treatment of IS.Methods: Randomized controlled trials (RCTs) of NSTC in the treatment of IS conducted before September 2018 were retrieved from five databases, according to specific inclusion and exclusion criteria. Two investigators independently reviewed the included studies and extracted relevant data. The methodological quality of the included studies was assessed using criteria from the Cochrane Handbook, and analyzed using Review Manager 5.3 software.Results: Thirteen RCTs comprising a total of 1,360 participants were included in this study. NSTC was shown to significantly improve the overall response rate (OR = 3.04, 95% CI [1.76, 5.26], P < 0.00001), and neurological function (NSTC increased Modified Barthel Index (MD = 8.15, 95% CI [3.79, 12.52], P = 0.0005), Functional Independence Measure (MD = 29.61, 95% CI [10.11, 49.10], P = 0.003) and European Stroke Scale scores (MD = 8.51, 95% CI [7.00, 10.01], P = 0.03). In addition, NSTC significantly increased serum adiponectin level (MD = 0.66, 95% CI [0.23, 1.08], P = 0.002). Moreover, NSTC reduced atherosclerotic plaque area (MD = -2.24, 95% CI [-4.02, -0.46], P = 0.01) and intima-media thickness (MD = -0.09, 95% CI [-0.13, -0.05], P < 0.0001). However, there was no significant difference between NSTC treatment and conventional therapy with respect to Fugl-Meyer Assessment score (MD = 10.59, 95% CI [-1.78, 22.96], P = 0.09) or Crouse score (MD = -0.78, 95% CI [-1.79, -0.22], P = 0.13).Conclusions: The results of this meta-analysis showed that NSTC exhibits efficacy in the treatment of cerebral infarction. NSTC can improve the overall response rate and neurological function, increase blood adiponectin, reduce neurological deficits, and decrease atherosclerotic plaque area.

The Efficacy and Safety of Ischemic Stroke Therapies: An Umbrella Review

“…As a result, previous meta-analyses have reported that the efficacy of blood-activating and stasis-dispelling herbs may be related to the severity of ischemic stroke. In addition, tPA, MTE plus tPA, MTE plus Stent Retrievers, blood-activating and stasisdispelling herbs plus XM was reported as only a modest but significant effect found on behavior in ischemic stroke patients (Peng et al, 2014;Punal-Rioboo et al, 2015;Kaesmacher et al, 2019;Shang et al, 2019;Zhang et al, 2019). In our study, Alpha1 was more effective for neurological improvement rate compared with placebo.…”

“…In all, 207 studies were excluded due to the following reasons: samples overlap with other studies (n = 80), no necessary sample data (n = 45), other outcomes (n = 27), other stroke (n = 20), other language (n = 17), no placebo group (n = 11), mild cognitive impairment (n = 7), (Figure 1). Thus, 43 studies were included in the umbrella review: Pan et al, 2020;Pan et al, 2020); Liu et al, 2021); (Liu et al, 2011);Blann et al, 2015); (Blann et al, 2015); Emberson et al, 2014) (Emberson et al, 2014); Peng et al, 2014); (Peng et al, 2014); Zhang et al, 2019); Shang et al, 2019); Puñal-Riobóo et al, 2015;Yuan et al, 2008;(Fu et al, 2013), Fan et al, 2014), Lin et al, 2014; Xu et al, 2015); Cao and Li, (2015); Marmagkiolis et al, 2015); Zheng et al, 2017), Li et al, 2017), Zhang et al, 2017), Chong et al, 2020); (Zhao et al, 2021), Li et al (2020); (Li et al, 2020), Gao et al, 2021); Huang et al, 2020); (Huang and Xiao, 2021), Liu et al, 2022), Feng et al, 2021, Lee et al (2010); Zhou et al, 2022); Hu et al, 2021); Lee, 2015, Liu et al, 2021); (Liu et al, 2021), Xin et al, 2020);…”

“…In general, the treatment for patients with ischemic stroke is aimed at promoting independence, clear embolism, maintaining function, and treating symptoms. Previous meta-analyses and reviews have focused on the possible effectiveness and safety of stem cell-based therapies, stent retrievers, acupuncture, MSCs, antiplatelet agents, statins, and blood-activating and stasis-dispelling herbs (Li et al, 2014;Cao and Li, 2015;Punal-Rioboo et al, 2015;Shang et al, 2019;Zhang et al, 2019;Li et al, 2020;Zhao et al, 2021;Zhou et al, 2022), even though patients experience modest efficacy and many adverse events with the treatment. As a result, we need to identify an efficacious and safe treatment paradigm for ischemic stroke patients.…”

Comparison of Traditional Chinese Medicine in the Long-Term Secondary Prevention for Patients with Ischemic Stroke: A Systematical Analysis

“…It is also extensively used for increasing blood circulation, eliminating blood stasis, and promoting nerve function recovery ( Liu et al, 2014 ). Moreover, a meta-analysis showed that NST has the effect of increasing blood adiponectin, decreasing neurological deficits, and reducing the area of atherosclerotic plaque ( Zhang et al, 2019 ). Since it has been widely used to treat ischemic stroke, Liu and Huang demonstrated that NST + WM is better than WM in recurrent stroke, and the results are significantly different ( Liu and Li, 2012 ; Huang et al, 2014 ).…”

Mitochondrial MPTP: A Novel Target of Ethnomedicine for Stroke Treatment by Apoptosis Inhibition

“…Most ethnic drugs for treatment of ischemic stroke have the function of activating blood circulation to remove blood stasis or clear collaterals. NaoShuanTong capsule (Zhang H. et al, 2019), ShenQi Fuzheng injection (Cai et al, 2016), ShengMai injection (Yang et al, 2016), and PeiYuan TongNao capsule have been reported to significantly improve the symptoms of ischemic stroke with few adverse events. In recent years, some antiapoptotic protective effects of cerebral ischemia have also been reported, such as XueShuanTong injection (Li et al, 2009) and QianCao NaoMaiTong mixture (Lu et al, 2016).…”