The comparative effects of oral Chinese patent medicines combined with western medicine in stable angina: A systematic review and network meta-analysis of 179 trials

Comparative efficacy of topical commercial Chinese polyherbal preparation for vulvovaginal candidiasis: a network meta-analysis

Objective

To systematically evaluate the differences in the efficacy of commonly used topical commercial Chinese polyherbal preparations (CCPPs) for vulvovaginal candidiasis (VVC), and to provide evidence-based reference for clinical drug regimens.

Methods

Computer searched major Chinese and English literature databases, and collected randomized controlled trials (RCTs) of external use of CCPPs combined with conventional treatment (CT, test group) versus CT alone (control group) in patients with VVC. After screening the literature, the quality of the included studies was assessed using the risk of bias assessment tool recommended in 5.3 of the Cochrane Handbook. Outcome data for each outcome measure were extracted and a network meta-analysis was performed using Stata 15.0.

Results

A total of 74 RCTs with a total of 8,151 patients were included, nine interventions were involved. The results of network meta-analysis showed that, Fufang Shajiziyou suppository combined with CT was more effective in improving the negative conversion rate and controlling the recurrence rate of Candida albicans. Kangfu gel combined with CT had the better effect in relieving pruritus. Baofukang suppository combined with CT was the most effective in reducing leukorrhea. Fufukang spray combined with CT had fewer adverse reactions.

Conclusion

The addition of CCPPs to CT may acquire a better curative effect in patients with VVC and external does not significantly increase the occurrence of adverse reactions. However, due to the low quality of the included literature, larger-scale, higher-quality clinical studies are still needed.

Systematic Review Registration

PROSPERO, NO: CRD42023410244.

Cost-effectiveness analysis of Shexiang Baoxin Pill (MUSKARDIA) as the add-on treatment to standard therapy for stable coronary artery disease in China

BACKGROUND

Recent evidence indicates that Shexiang Baoxin Pill (MUSKARDIA), as an add-on treatment to standard therapy for stable coronary artery disease (CAD), is effective. Nevertheless, the cost-effectiveness of introducing the Shexiang Baoxin Pill (Abbreviation SBP) to the current standard treatment for patients with CAD in China remains unknown.

OBJECTIVE

The objective of this study was to assess the cost-effectiveness of introducing SBP into the current standard treatment in China for patients with CAD.

METHOD

The effects of two treatment strategies-the SBP group (SBP combined with standard therapy) and the standard therapy group (placebo combined with standard therapy)-were simulated using a long-term Markov model. The simulation subjects might experience non-fatal MI and/or stroke or vascular or non-vascular death events. The study parameters were primarily derived from the MUSKARDIA trial, which was a multicenter, double-blind, placebo-controlled phase IV randomized clinical trial. Furthermore, age-related change, event costs, and event utilities were drawn from publicly available sources. Both costs and health outcomes were discounted at 5.0% per annum. One-way and probabilistic sensitivity analyses were conducted to verify the robustness of the model. Based on the MUSKARDIA trial results, the risk with the events of major adverse cardiovascular events (MACE) was decreased (P < 0.05) in the female subgroup treated with SBP therapy compared with standard therapy. Consequently, a scenario analysis based on subgroups of Chinese females was conducted for this study. Incremental cost-effectiveness ratios (ICERs) were assessed for each strategy for costs per quality-adjusted life-year (QALY) saved.

RESULTS

After 30 years of simulation, the SBP group has added 0.32 QALYs, and the cost has been saved 841.00 CNY. Compared with the standard therapy, the ICER for the SBP therapy was -2628.13 CNY per QALY. Scenario analyses of Chinese females showed that, after 30 years of simulation, the SBP therapy has been increased by 0.82 QALYs, and the cost has been reduced by 19474.00 CNY. Compared with the standard therapy, the ICER for the SBP therapy was -26569.51 CNY per QALY. Similar results were obtained in various extensive sensitivity analyses.

CONCLUSIONS

This is the first study to evaluate the cost-effectiveness of SBP in the treatment of CAD. In conclusion, SBP as an add-on treatment to standard therapy appears to be a cost-effective strategy for CAD in Chinese patients.

Integrated Chinese and Western medicine for stable angina pectoris of coronary heart disease: a real-world study including 690 patients

Objective

We aimed to evaluate the effects of integrated Chinese and Western medical therapeutic modalities on clinical prognosis in a population with stable angina pectoris (SAP) of coronary heart disease (CHD).

Methods

In a prospective cohort study, 732 patients with SAP of CHD hospitalized in the Integrated Cardiology Unit of the China-Japan Friendship Hospital From October 2020 to October 2021 were included. The patients were divided into integrated treatment and conventional treatment groups according to whether they had been taking Chinese medicine for more than 6 months per year. The occurrence of composite cardiovascular events (CVEs), including cardiac death, non-fatal myocardial infarction, revascularization, stroke, all-cause death, and readmission due to angina attack, heart failure, or malignant arrhythmia, was recorded during follow-up. The effects of different treatment modalities on prognosis were evaluated using univariate and multifactorial logistic regression. Logistic regression models were evaluated using receiver operating characteristic (ROC) curves. In sensitivity analysis, the correlation between treatment modality and outcome events was corrected by rematching the two groups of patients using the propensity score matching (PSM) method.

Results

The data from 690 patients were included in the analysis, with 327 patients in the integrated treatment group and 363 patients in the conventional treatment group. CVEs occurred in 19 patients (5.8%) in the integrated treatment group and 37 patients (10.2%) in the conventional treatment group. The proportion of outcome events was significantly lower in the combination treatment group than in the conventional treatment group (P = 0.037). Covariate correction by multimodal multifactorial logistic regression revealed a lower risk of CVEs in patients receiving integrated therapy compared with conventional therapy (OR = 0.246, 95% CI = 0.097-0.622, P = 0.003). Moreover, a history of renal insufficiency (OR = 3.991, 95% CI = 1.164-13.684, P = 0.028) and a higher Gensini score (OR = 1.039, 95% CI = 1.028-1.050, P < 0.001) were risk factors for the development of CVEs. Model evaluation showed that C-statistic = 0.955 and area under the ROC curve (AUC) = 0.955. After PSM correction, the results still showed that integrated Chinese and Western medical treatment reduced the occurrence of CVEs in patients compared with Western treatment alone (OR = 0.339, 95% CI = 0.131-0.874, P = 0.025).

Conclusion

Integrated treatment based on Chinese and Western medicine might improve the prognosis and reduce the risk of CVEs in this disease population.

Trial registration

China Clinical Trials Registry, ChiCTR1800017891, Registered 20 August 2018, http://www.chictr.org.cn/showproj.aspx?proj = 30170.