The Efficacy and Safety of Zhengqing Fengtongning for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract

Background. Zhengqing Fengtongning release tablet (ZQFTN) is a proprietary Chinese medicine preparation of sinomenine, the main active component of the traditional Chinese medicine (TCM) Sinomenium acutum. It is used in China as a complementary and alternative medicine (CAM) for knee osteoarthritis (KOA). The objective of this study was to evaluate the clinical efficacy and safety of ZQFTN in KOA treatment. Method. Randomized controlled trials of ZQFTN in KOA treatment were searched in PubMed, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, and Wanfang database. Two reviewers independently conducted the screening, extracted the data, and assessed the methodological quality. Statistical analysis was performed using RevMan 5.3 software. Results. Eighteen studies were assessed that included 1512 participants (757 in the treatment group and 755 in the control group). The results showed that compared with the control group, the Visual Analogue Scale (standardized mean difference (SMD) = −0.87, 95% confidence interval (CI): [−1.08, −0.66], P < 0.001 ), Western Ontario and Mc Master University (WOMAC) Osteoarthritis Index pain score (SMD = −0.67, 95% CI: [−0.88, −0.46], P < 0.001 ), WOMAC stiffness score (SMD = −0.53, 95% CI: [−0.86, −0.20], P = 0.001 ), WOMAC function score (SMD = −0.76, 95% CI: [−0.97, −0.55], P < 0.001 ), serum interleukin-1β level (SMD = −4.36, 95% CI: [−6.41, −2.31], P < 0.001 ), and serum tumor necrosis factor-α level (SMD = −8.45, 95% CI: [−11.20, −5.69], P < 0.001 ) of the ZQFTN treatment group were lower, and the total effective rate was higher relative risk (RR = 1.15, 95% CI [1.07, 1.23], P < 0.001 ). There was no significant difference in the incidence of adverse reactions between the two groups (RR = 0.96, 95% CI: [0.69, 1.35], P = 0.82 ). Conclusion. ZQFTN can effectively relieve knee pain, morning stiffness, and daily activity function disorders, reduce the expression of inflammatory factors in serum, and improve the total clinical response rate without increasing the incidence of adverse reactions. Therefore, ZQFTN has considerable potential as a CAM for KOA. However, due to the limitation of the quality of the included studies, the strength of this conclusion is affected. In the next step, multicenter, large sample, high-quality randomized controlled studies are needed to further confirm the present conclusion.

The Analysis Study of Association of Pharmacological Treatments With Long-Term Pain Control in Patients With Knee Osteoarthritis : A Comprehensive Systematic Review

“…However, quality limitations need further confirmation. 15 Lin's study demonstrates that CHM, either as an adjuvant or monotherapy, effectively reduces VAS, WOMAC, and Lequesne index in patients with KOA. CHM is well-tolerated and safe, potentially contributing to the formulation of a herbal formula for further clinical use.…”

The efficacy and safety of condoliase for lumbar disc herniation: a systematic review and meta-analysis

“…Review Manager 5.3. was used to analyse the clinical data. For the two-arm study with a control group, count data were evaluated Frontiers in Pharmacology frontiersin.org using relative risk (RR) and 95% confidence interval (CI), and measurement data were analysed using the standardized mean difference (SMD) and 95%CI (Huang et al, 2022). For the single-arm study without a control group, the risk difference (RD, %) and 95%CI were used to analyse the event rate (Wang et al, 2021).…”

“…The improved Newcastle-Ottawa scale (NOS) was used to evaluate the quality of non-RCT studies. Based on the original NOS scale, two questions related to the selection and comparison of non-exposed patients and one question related to the evaluation results were reduced, and the question of whether there was financial sponsorship from pharmaceutical enterprises was added ( Stang, 2010 ; Huang et al, 2022 ). Any inconsistencies were scrutinised by a third reviewer (XS).…”

Molecular Mechanistic Pathways Targeted by Natural Compounds in the Prevention and Treatment of Diabetic Kidney Disease

“…In clinical studies, sinomenine has a potent anti-inflammatory effect. It has been formulated into tablets and injections for the treatment of knee osteoarthritis [ 108 , 109 ]. With the application of sinomenine, its adverse reactions, such as allergic reactions, nausea, and vomiting, have gradually attracted attention, which may be related to the bidirectional regulation of histamine release by sinomenine [ 110 ].…”