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

44 Pages Posted: 14 Jul 2022

See all articles by Mei Kwan Lai

Mei Kwan Lai

The Chinese University of Hong Kong - Department of Medicine & Therapeutics

Cho Wing Lo

The Chinese University of Hong Kong

Hongwei Zhang

The Chinese University of Hong Kong

Chi Him Sum

The Chinese University of Hong Kong

Kam Leung CHAN

The Chinese University of Hong Kong

Pui Kuan Cheong

The Chinese University of Hong Kong - Department of Medicine & Therapeutics

Tianhe Song

The Chinese University of Hong Kong

Zhixiu LIN

The Chinese University of Hong Kong

Siew C. Ng

The Chinese University of Hong Kong - Department of Medicine & Therapeutics

Justin Wu

The Chinese University of Hong Kong - Department of Medicine & Therapeutics

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

Suggested Citation

Lai, Mei Kwan and Lo, Cho Wing and Zhang, Hongwei and Sum, Chi Him and CHAN, Kam Leung and Cheong, Pui Kuan and Song, Tianhe and LIN, Zhixiu and Ng, Siew C. and Wu, Justin, Chinese Herbal Medicines Complementary to Mesalazine for Ulcerative Colitis: A Systematic Review with Meta-Analysis. Available at SSRN: https://ssrn.com/abstract=4162345 or http://dx.doi.org/10.2139/ssrn.4162345

Mei Kwan Lai

The Chinese University of Hong Kong - Department of Medicine & Therapeutics ( email )

Cho Wing Lo

The Chinese University of Hong Kong ( email )

Hongwei Zhang (Contact Author)

The Chinese University of Hong Kong ( email )

Chi Him Sum

The Chinese University of Hong Kong ( email )

Kam Leung CHAN

The Chinese University of Hong Kong ( email )

Pui Kuan Cheong

The Chinese University of Hong Kong - Department of Medicine & Therapeutics ( email )

Tianhe Song

The Chinese University of Hong Kong ( email )

Zhixiu LIN

The Chinese University of Hong Kong ( email )

Siew C. Ng

The Chinese University of Hong Kong - Department of Medicine & Therapeutics ( email )

Justin Wu

The Chinese University of Hong Kong - Department of Medicine & Therapeutics ( email )

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