Effect of Chinese Herbal Compound LC09 on Patients With Capecitabine-Associated Hand-Foot Syndrome: A Randomized, Double-Blind, and Parallel-Controlled Trial

A systematic review of 454 randomized controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries

BACKGROUND

Over 29 years of clinical application, the Dermatology Life Quality Index (DLQI) has remained the most used patient-reported outcome (PRO) in dermatology due to its robustness, simplicity and ease of use.

OBJECTIVES

To generate further evidence of the DLQI's utility in randomized controlled trials (RCTs) and to cover all diseases and interventions.

METHODS

The methodology followed PRISMA guidelines and included seven bibliographical databases, searching articles published from 1 January 1994 until 16 November 2021. Articles were reviewed independently by two assessors, and an adjudicator resolved any opinion differences.

RESULTS

Of 3220 screened publications, 454 articles meeting the eligibility criteria for inclusion, describing research on 198 190 patients, were analysed. DLQI scores were primary endpoints in 24 (5.3%) of studies. Most studies were of psoriasis (54.1%), although 69 different diseases were studied. Most study drugs were systemic (85.1%), with biologics comprising 55.9% of all pharmacological interventions. Topical treatments comprised 17.0% of total pharmacological interventions. Nonpharmacological interventions, mainly laser therapy and ultraviolet radiation treatment, comprised 12.2% of the total number of interventions. The majority of studies (63.7%) were multicentric, with trials conducted in at least 42 different countries; 40.2% were conducted in multiple countries. The minimal clinically importance difference (MCID) was reported in the analysis of 15.0% of studies, but only 1.3% considered full score meaning banding of the DLQI. Forty-seven (10.4%) of the studies investigated statistical correlation of the DLQI with clinical severity assessment or other PRO/quality of life tools; and 61-86% of studies had within-group scores differences greater than the MCID in 'active treatment arms'. The Jadad risk-of-bias scale showed that bias was generally low, as 91.8% of the studies had Jadad scores of ≥ 3; only 0.4% of studies showed a high risk of bias from randomization. Thirteen per cent had a high risk of bias from blinding and 10.1% had a high risk of bias from unknown outcomes of all participants in the studies. In 18.5% of the studies the authors declared that they followed an intention-to-treat protocol; imputation for missing DLQI data was used in 34.4% of studies.

CONCLUSIONS

This systematic review provides a wealth of evidence of the use of the DLQI in clinical trials to inform researchers' and -clinicians' decisions for its further use. Recommendations are also made for improving the reporting of data from future RCTs using the DLQI.

Chemotherapy-induced hand foot syndrome: comparative efficacy and safety of pharmacological prophylaxis - systematic review and Bayesian network meta-analysis

BACKGROUND

Hand-foot syndrome (HFS) is one of the most common toxicities experienced by patients receiving systemic chemotherapy agents such as capecitabine and multikinase inhibitors such as sorafenib. Several randomised controlled trials (RCTs) have investigated the efficacy and safety of prophylactic agents such as pyridoxine, celecoxib, urea cream and cystine/theanine in managing HFS. This network meta-analysis (NMA) evaluated data from high-quality trials to provide strong evidence in forming recommendations to prevent systemic cancer therapy-induced HFS.

OBJECTIVE

To examine the comparative efficacy and safety of interventions for preventing systemic chemotherapy-induced HFS in patients with cancer.

METHODS

We searched PubMed, Embase and clinical trial registry for RCTs of interventions for preventing HFS. Bayesian NMA was performed to estimate the OR with 95% credible intervals (CrI) from both direct and indirect evidence. The outcome measures were the incidence of HFS (grade ≥1) and moderate to severe HFS (grade ≥2). Adverse drug reactions were discussed descriptively.

RESULTS

A total of 15 RCTs with 2715 patients with 12 prophylactic strategies were included. The analysis showed only celecoxib could significantly prevent the incidence of moderate to severe HFS (grade ≥2) (OR 0.29, 95% CrI 0.13 to 0.68). But none of the preventive interventions could prevent the incidence of HFS (grade ≥1).

CONCLUSION

Only celecoxib (200 mg two times per day) showed significant prevention of the incidence of moderate to severe HFS. Pyridoxine (400 mg once daily) and urea cream (10%) have to be evaluated further in larger randomised trials.

Geranium wilfordii maxim.: A review of its traditional uses, phytochemistry, pharmacology, quality control and toxicology

ETHNOPHARMACOLOGICAL RELEVANCE

Geranium wilfordii Maxim. (family Geraniaceae) has been used as a multifunctional ethnomedicine in China for more than 600 years. There have been records about the edible and medicinal use of G.wilfordii since the Ming Dynasty. Nowadays, G.wilfordii is included in Chinese Pharmacopoeia as the Geranii Herba, and has been widely used to treat rheumatism, infectious diseases, dermatosis and tumors. In addition, more than 30 kinds of Chinese patent medicines containing G.wilfordii have been marketed in China for its high medicinal value.

AIM OF THE REVIEW

The present review systematically summarized the traditional uses, phytochemistry, pharmacology, quality control and toxicology of G.wilfordii, discussed the development potential of this plant and analyzed the shortcomings of existing research, in order to provide comprehensive scientific basis for the medical application and help interested researchers discover safe and medicinal natural products from G.wilfordii.

MATERIALS AND METHODS

We performed a systematic search of G.wilfordii by collecting the publications between 1995 and 2021 via PubMed, Web of Science, SciFinder, Google Scholar, Chinese National Knowledge Infrastructure database, Wanfang database and other databases using the keywords including Geranium wilfordii Maxim., botany, traditional uses, Chinese patent medicines, patents, preparations, phytochemistry, biological activity, quality and toxicity. Besides, part of the information also came from Chinese botanical and medical monographs.

RESULTS

So far, more than 90 components have been identified from G.wilfordii, among which tannins as well as flavonoids have attracted widespread concerns. Due to the multi-components nature, a wide range of beneficial biological activities of G.wilfordii have been demonstrated, including anti-inflammatory, antibacterial, antiviral, anti-tumor, antioxidative, hepatoprotective, gastrointestinal protective, immunoregulatory and uric acid-lowering effects.

CONCLUSION

A long history of traditional uses and abundant pharmacochemical and pharmacological studies have shown that G.wilfordii is an important natural medicine, which exerts outstanding therapeutic effects especially in anti-inflammation and anti-microorganisms. However, the present researches on the active ingredients and the mechanism of action are not in-depth enough, and more evidence-based scientific studies are needed to lend credence to the traditional uses of G.wilfordii. Additionally, limited toxicology tests cannot objectively evaluate the safety of G.wilfordii, which needs to be further supplemented. Further, more attention needs to be paid to the selection of index components of quality control research.