Chinese Herbal Medicines Complementary to Mesalazine for Ulcerative Colitis: A Systematic Review with Meta-Analysis

Abstract

Ethnopharmacological relevance: Mesalazine was the most commonly used drug for mild-moderate ulcerative colitis. Previous studies have shown that Chinese herbal medicines (CHMs) complementary to mesalazine might offer additional benefits. However, there is still no clear evidence on the effectiveness and safety of CHMs complementary to conventional medicine.Aim of the studyTo evaluate the treatment effectiveness and safety of the complementary use of oral CHMs together with mesalazine for the treatment of ulcerative colitis.

Materials and Methods: A systematic review and meta-analysis of randomised controlled trials of mesalazine plus CHMs versus mesalanzine in the patients with ulcerative colitis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Four main English-based electronic databases (Cochrane Library, MEDLINE, EMBASE and AMED (Allied and Complementary Medicine)) and three main Chinese-based databases (Sinomed, WanFang Med Online and China National Knowledge Infrastructure (CNKI)) were searched from their inception until November 2019. The Cochrane Handbook for Systematic Reviews of Interventions was used for methodological quality and independent evaluation. Review Manager 5.1 was used for data analysis. Improvement of clinical response was the primary outcome. The improvement on colonic mucosa under endoscopy, Chinese medical clinical response and clinical outcomes based on Chinese medical syndrome differentiation were secondary outcomes.

Results: Sixty-seven randomised controlled studies were inlcuded. All studies were conducted in China. Different compound Chinese herbal medical preparations were used. Chinese goldthread, Chinese pulsatilla root, white peony root, codonopsis and argehead atractylodes rhizome were the 5 top frequently used herbs. Pooled analysis showed that Chinese herbal medicines plus mesalazine had better effects on enhancing clinical improvement rate (RR = 0.40, 95% CI 0.32 to 0.49, N = 2,041), decreasing the Mayo score (MD = -1.31, 95% CI -1.91 to -0.70, N = 210) and DAI score (MD = -2.63, 95% CI -3.28 to -1.99, N = 468), when compared mesalazine alone. CHMs also showed benefical addd-on effects on improving endoscopic findings.

Conclusion: The findings suggest that integrated Chinese herbal medicines with mesalazine showed better effects on improving clinical symptoms and endoscopic findings for patients with ulcerative colitis than mesalazine alone. However, due to some methodological limitations in the included studies, the currently available evidence is still too weak to generate a conclusive result.

Note:

Funding Information: None.

Declaration of Interests: The authors confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Keywords: CHINESE MEDICINE, mesalazine, Ulcerative Colitis, systematic review, meta-analysis, herb