Methodological and reporting quality evaluation of meta-analyses on the Chinese herbal preparation Zheng Qing Feng Tong Ning for the treatment of rheumatoid arthritis

Abstract

Background: Zheng Qing Feng Tong Ning (ZQFTN) is a sinomenine (SIN) preparation that has been used in clinical practice. Our study aimed to assess the methodological and reporting quality of meta-analyses on the Chinese herbal formula ZQFTN for the treatment of rheumatoid arthritis (RA). Methods: Systematic searches were carried out with the 5 following electronic databases from inception to July 2019: China National Knowledge Infrastructure (CNKI), Wanfang, VIP database for Chinese technical periodicals (VIP), Cochrane Library and PubMed. The quality of the methodology and reporting was measured with the assessment of multiple systematic reviews 2 (AMSTAR 2) scale, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: Eight studies were identified. Among the 16 items of the AMSTAR 2 scale, four items were optimally reported ("Y" =100% of the items), and another four items were poorly reported ("Y" =0% of the items). Only 2 studies received a good overall score ("Y" ≥50% of the items). Regarding the PRISMA statement, the scores of 5 studies were lower than the average score (17.69), indicating that the quality of the reports was very low. In terms of the GRADE, none of the 61 results were of high quality (0.0%). Fifteen results were of medium quality (25%), 34 were of low quality (55%), and 12 were of very low quality (20%). Among the five downgrading factors, deviation risk (n = 61, 100%) was the most common downgrading factor, followed by inconsistency (n = 30, 50%), publication bias (n = 17, 28%), inaccuracy (n = 11, 18%) and indirectness (n = 0, 0%).

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“…Another study that assessed the quality of meta-analyses of Chinese herbal preparations for the treatment of rheumatoid arthritis concluded that most outcomes (55%) were of low quality. In comparison, 25% and 20% were of moderate and very low quality, respectively, primarily because of the risk of bias and inconsistency [ 80 ]. Quality assessment of the evidence on the role of the dietary supplement curcumin in the treatment of ulcerative colitis yielded 10 moderate, 6 low, and 3 very low certainties of the evidence.…”

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“…An overview of systematic reviews is a commonly used method to summarize the results of published meta-analyses in a specific healthcare field, [12–14] and it has been widely used in various areas, such as rheumatoid arthritis, [15] snakebite envenoming, [16] and appendicitis [17] . A network meta-analysis is a tool for comparing and pooling evidence from multiple interventions, [18,19] as well as providing a relative ranking of these interventions in terms of clinical outcome [18,19] .…”