Qili Qiangxin Capsule Combined With Sacubitril/Valsartan for HFrEF: A Systematic Review and Meta-Analysis

Xiang, Qing; Wang, Mengxi; Ding, Yuhan; Fan, Manlu; Tong, Huaqin; Chen, Jiandong; Yu, Peng; Shen, Le; Chen, Xiaohu

doi:10.3389/fphar.2022.832782

Cited by 8 publications

(5 citation statements)

References 44 publications

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“…However, the six CTPMs displayed different therapeutic advantages, which may be due to the fact that although all of them can boost qi and invigorate blood, their effects are focused differently. QLQXC can also warm yang and promote urination and is mostly used for patients who have developed edema due to yang deficiency in the late stage of the disease, rendering it more suitable for the treatment of HFrEF ( 92 ). YXSC focuses on replenishing qi and nourishing yin and is suitable for those with deficiency of both qi and yin, but the role of yin deficiency in the pathogenesis of HFPEF is less important.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Chinese traditional patent medicines for heart failure with preserved ejection fraction: a Bayesian network meta-analysis of 64 randomized controlled trials

Guo,

Zhu,

et al. 2023

Front. Cardiovasc. Med.

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BackgroundHeart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality, and modern medicine offers less effective treatment for HFpEF. Much evidence shows that Chinese traditional patent medicines (CTPMs) have good efficacy for HFpEF, but the advantages and disadvantages of different CTPMs for HFpEF are still unclear. This study used network meta-analysis (NMA) to compare clinical efficacies of different CTPMs for HFpEF.MethodsRandomized controlled trials (RCTs) of CTPMs for treating HFpEF were searched in seven Chinese and English databases from inception to September 2023: China National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biology Medicine, PubMed, Cochrane Library, and Embase. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies. The GeMTC package in R (version 4.1.2) was used to perform Bayesian NMA.ResultsA total of 64 RCTs were included, involving six CTPMs and 6,238 patients. The six CTPMs were Qili Qiangxin capsule (QLQXC), Qishen Yiqi dropping pill (QSYQDP), Yixinshu capsule (YXSC), Yangxinshi tablet (YXST), Shexiang Baoxin Pill (SXBXP), and Tongxinluo capsule (TXLC). Conventional Western medicine (CWM) treatment was given to the control group, and CWM treatment combined with CTPM treatment was given to the experimental group. The results indicated that CPTMs + CWM were all superior to CWM alone; SXBXP + CWM had the best efficacies in improving the New York Heart Association cardiac functional classification efficiency; TXLC + CWM was best at improving the ratio of early diastolic mitral inflow velocity to late diastolic mitral inflow velocity (E/A); QSYQDP + CWM was best at reducing N-terminal pro-B type natriuretic peptide (NT-proBNP); and QSYQDP + CWM was best at improving the 6-min walking test. In terms of safety, there was no signiﬁcant difference between CTPMs + CWM and CWM.ConclusionCompared with CWM alone, CTPMs + CWM combinations have certain advantages and good safety in the treatment of HFpEF. QSYQDP + CWM and SXBXP + CWM may be the potential optimal integrative medicine-based treatments for HFpEF. Given the limitations of this study, further high-quality, multicenter, large sample, randomized, and double-blind studies are needed to confirm the current results.Systematic Review Registrationidentifier, CRD42022303938.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Chinese traditional patent medicines for heart failure with preserved ejection fraction: a Bayesian network meta-analysis of 64 randomized controlled trials

Guo,

Zhu,

et al. 2023

Front. Cardiovasc. Med.

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“…Terefore, although BCG-PSN cannot replace antihistamines as frst-line drugs, it can be used in combination with antihistamines to play a synergistic role with antihistamines in the acute attack stage and regulate immunity to reduce recurrence in the stable stage [58]. Furthermore, BCG-PSN can increase EOS levels [16] and upregulate Blymphocytes levels [59].…”

Section: Discussionmentioning

confidence: 99%

“…Last, the content of data extraction is recommended to include publication characteristics of the literature, basic characteristics of research objects, and methodological characteristics. Te extracted data are cross checked; a third reviewer will be settled to consulting, if necessary [16].…”

Section: Study Selection and Data Managementmentioning

confidence: 99%

Effects of BCG‐PSN on the Levels of Inflammatory Factors and Th1/Th2 Differentiation in Chronic Spontaneous Urticaria: Meta‐Analysis and Systematic Review

Fu,

Huang,

Zhou

et al. 2023

Dermatologic Therapy

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Background. Bacillus Calmette–Guerin polysaccharide nucleic acid (BCG-PSN), as an immune modulator, can effectively regulate the immune function of the body, control the release of histamine inflammatory substances, and achieve allergic effects against chronic spontaneous urticaria (CSU). This study aimed to evaluate the effectiveness of BCG-PSN on the levels of inflammatory factors and Th1/Th2 differentiation in CSU. Methods. A systemic literature search of BCG-PSN treatment of CSU was performed using the PubMed, Cochrane Library, Web of Science, CBM, and other databases. A quantitative meta-analysis was conducted according to the guidelines of the Cochrane Handbook. Review manager software 5.4 was used for meta-analysis. Results. Twenty-seven studies pertaining to 2840 patients were included. The duration of treatment was 4 to 12 weeks. BCG-PSN can increase CD3+T levels (MD = 6.06; 95% CI: 5.30 to 6.82; p < 0.00001; I2 = 31%), CD4+T levels (MD = 5.41; 95% CI: 4.82 to 6.01; p < 0.00001; I2 = 40%), and CD4+/CD8+(MD = 0.33; 95% CI: 0.28 to 0.38; p < 0.00001; I2 = 15%); at the same time, BCG-PSN can downregulate CD8+T levels (MD = −3.28; 95% CI: −3.82 to −2.74; p < 0.00001; I2 = 32%). Furthermore, BCG-PSN could downregulate IL-4 levels (MD = −4.06, 95% CI: −5.15 to −2.97, p < 0.00001; I2 = 0%), TNF-α levels (MD = −2.34; 95% CI: −3.01 to −1.66; p < 0.00001; I2 = 26%) and upregulate IL-10 levels (MD = 25.59, 95% CI: 23.50 to 27.69, p < 0.00001; I2 = 0%) and INF-γ levels (MD = 4.62, 95% CI: 3.79 to 5.45, p < 0.00001; I2 = 5%). Conclusions. BCG-PSN can regulate the levels of inflammatory factors and Th1/Th2 differentiation in CSU. However, the long-term effectiveness and more objective experimental indicators of BCG-PSN remain to be further studied. Trial Registration. This trial is registered with PROSPERO ID: CRD42022332475.

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“…A meta-analyses by Xu et al 18 reached similar conclusions. Two smaller meta-analyses 19,20 that evaluated the efficacy of QLQX in patients with heart failure already receiving sacubitril/valsartan reported an improvement in ejection fraction and 6-min walk distance, but the authors raised important methodological concerns with the underlying trials.…”

Section: Randomized Controlled Clinical Trials With Qiliqiangxin In H...mentioning

confidence: 99%

Qiliqiangxin: A multifaceted holistic treatment for heart failure or a pharmacological probe for the identification of cardioprotective mechanisms?

Packer

2023

European J of Heart Fail

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The active ingredients in many traditional Chinese medicines are isoprene oligomers with a diterpenoid or triterpenoid structure, which exert cardiovascular effects by signaling through nutrient surplus and nutrient deprivation pathways. Qiliqiangxin (QLQX) is a commercial formulation of 11 different plant ingredients, whose active compounds include astragaloside IV, tanshione IIA, ginsenosides (Rb1, Rg1 and Re) and periplocymarin. In the QUEST Trial, QLQX reduced the combined risk of cardiovascular death or heart failure hospitalization (hazard ratio 0.78 [95% CI 0.68‐0.90]), based on 859 events in 3119 patients over a median of 18.2 months; the benefits were seen in patients taking foundational drugs except for SGLT2 inhibitors. Numerous experimental studies of QLQX in diverse cardiac injuries have yielded highly consistent findings. In marked abrupt cardiac injury, QLQX mitigated cardiac injury by upregulating nutrient surplus signaling through the PI3K/Akt/mTOR/HIF‐1α/NRF2 pathway; the benefits of QLQX were abrogated by suppression of PI3K, Akt, mTOR, HIF‐1α or NRF2. In contrast, in prolonged measured cardiac stress (as in chronic heart failure), QLQX ameliorated oxidative stress, maladaptive hypertrophy, cardiomyocyte apoptosis, and proinflammatory and profibrotic pathways, while enhancing mitochondrial health and promoting glucose and fatty acid oxidation and ATP production. These effects are achieved by an action of QLQX to upregulate nutrient deprivation signaling through SIRT1/AMPK/PGC‐1α and enhanced autophagic flux. In particular, QLQX appears to enhance the interaction of PGC‐1α with PPARα, possibly by direct binding to RXRα; silencing of SIRT1, PGC‐1α and RXRα abrogated the favorable effects of QLQX in the heart. Since PGC‐1α/RXRα is also a downstream effector of Akt/mTOR signaling, the actions of QLQX on PGC‐1α/RXRα may explain its favorable effects in both acute and chronic stress. Intriguingly, the individual ingredients in QLQX — astragaloside IV, ginsenosides, and tanshione IIA — share QLQX's effects on PGC‐1α/RXRα/PPARα signaling. QXQL also contains periplocymarin, a cardiac glycoside that inhibits Na+‐K+‐ATPase. Taken collectively, these observations support a conceptual framework for understanding the mechanism of action for QLQX in heart failure. The high likelihood of overlap in the mechanism of action of QLQX and SGLT2 inhibitors requires additional experimental studies and clinical trials.This article is protected by copyright. All rights reserved.

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Qili Qiangxin Capsule Combined With Sacubitril/Valsartan for HFrEF: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 44 publications

Efficacy of Chinese traditional patent medicines for heart failure with preserved ejection fraction: a Bayesian network meta-analysis of 64 randomized controlled trials

Efficacy of Chinese traditional patent medicines for heart failure with preserved ejection fraction: a Bayesian network meta-analysis of 64 randomized controlled trials

Effects of BCG‐PSN on the Levels of Inflammatory Factors and Th1/Th2 Differentiation in Chronic Spontaneous Urticaria: Meta‐Analysis and Systematic Review

Qiliqiangxin: A multifaceted holistic treatment for heart failure or a pharmacological probe for the identification of cardioprotective mechanisms?

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