Efficacy and Safety of Traditional Chinese Herbal Medicine for Antipsychotic-Related Constipation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Constipation is a common but often ignored side effect of antipsychotic treatment, although it is associated with adverse outcomes. The results of the efficacy and safety of traditional Chinese herbal medicine (TCM) in treating constipation are mixed across studies. This is a systematic review and meta-analysis of randomized controlled trials (RCTs) of the efficacy and safety of TCM compared to Western medicine (WM) in treating antipsychotic-related constipation.Methods: Major international electronic (PubMed, EMBASE, Cochrane Library, and Web of Science) and Chinese (Wanfang, WeiPu VIP, SinoMed, and CNKI) databases were searched from their inception to November 29, 2020. Meta-analysis was performed using the random-effects model.Results: Thirty RCTs with 52 arms covering 2,570 patients in the TCM group and 2,511 patients in the WM group were included. Compared with WM, TCM alone was superior regarding the moderate response rate [risk ratio (RR) = 1.165; 95% confidence interval (CI): 1.096–1.238; P < 0.001], marked response rate (RR = 1.437; 95% CI: 1.267–1.692; P < 0.001), and remission rate (RR = 1.376; 95% CI: 1.180–1.606; P < 0.001) for constipation, while it was significantly associated with lower risk of rash (RR = 0.081; 95% CI: 0.019–0.342; P = 0.001). For the moderate response rate, meta-regression analyses revealed that publication year (β = −0.007, P = 0.0007) and Jadad score (β = 0.067, P < 0.001) significantly moderated the results. For the remission rate, subgroup and meta-regression analyses revealed that the geographical region (P = 0.003), inpatient status (P = 0.035), and trial duration (β = 0.009, P = 0.013) significantly moderated the results.Conclusions: The efficacy of TCM for antipsychotic-related constipation appeared to be greater compared to WM, while certain side effects of TCM, such as rash, were less frequent.

Flavonoids in Amomum tsaoko Crevost et Lemarie Ameliorate Loperamide-Induced Constipation in Mice by Regulating Gut Microbiota and Related Metabolites

“…At this stage, the application of medications for constipation is still the predominant treatment and can be divided into herbal, Western, and microbial drugs, but the common drugs are still laxatives and prokinetics, which have all been found to have varying degrees of adverse effects in clinical application [ 1 ]. Therefore, it is of great clinical value and urgency to investigate a safe, effective and inexpensive gastrointestinal stimulant based on edible natural plant material for the treatment of chronic functional constipation [ 3 ]. Amomum tsaoko Crevost et Lemarie (AT) is a classic spice commonly used to make soups in Asian countries such as China, Thailand, Burma, and Vietnam.…”

Molecular Mechanism of the Therapeutic Effect of Peach Blossom against Constipation: An Exploratory Study Based on Network Pharmacology Analysis and Molecular Docking Verification

“…Both alone and in combination with other TCM applications, obvious efficacy without toxic side effects has been observed. In addition, it has been reported that the therapeutic effect of TCM on antipsychogenic constipation was more effective than that of western medicines, such as phenolphthalein and glycerin enema [ 10 ].…”