Five commonly used traditional Chinese medicine formulas in the treatment of ulcerative colitis: A network meta-analysis

Abstract

Background: Currently, traditional Chinese medicine (TCM) formulas are commonly being used as adjunctive therapy for ulcerative colitis in China. Network meta-analysis, a quantitative and comprehensive analytical method, can systematically compare the effects of different adjunctive treatment options for ulcerative colitis, providing scientific evidence for clinical decision-making.

Aim: To evaluate the clinical efficacy and safety of commonly used TCM for the treatment of ulcerative colitis (UC) in clinical practice through a network meta-analysis.

Methods: Clinical randomized controlled trials of these TCM formulas used for the adjuvant treatment of UC were searched from the establishment of the databases to July 1, 2022. Studies that met the inclusion criteria were screened and evaluated for literature quality and risk of bias according to the Cochrane 5.1 standard. The methodological quality of the studies was assessed using ReviewManager (RevMan) 5.4, and a funnel plot was constructed to test for publication bias. ADDIS 1.16 statistical software was used to perform statistical analysis of the treatment measures and derive the network relationship and ranking diagrams of the various intervention measures.

Results: A total of 64 randomized controlled trials involving 5456 patients with UC were included in this study. The adjuvant treatment of UC using five TCM formulations was able to improve the clinical outcome of the patients. Adjuvant treatment with Baitouweng decoction (BTWT) showed a significant effect [mean difference = 36.22, 95% confidence interval (CI): 7.63 to 65.76]. For the reduction of tumor necrosis factor in patients with UC, adjunctive therapy with BTWT (mean difference = -9.55, 95%CI: -17.89 to -1.41), Shenlingbaizhu powder [SLBZS; odds ratio (OR) = 0.19, 95%CI: 0.08 to 0.39], and Shaoyao decoction (OR = -23.02, 95%CI: -33.64 to -13.14) was effective. Shaoyao decoction was more effective than BTWT (OR = 0.12, 95%CI: 0.03 to 0.39), SLBZS (OR = 0.19, 95%CI: 0.08 to 0. 39), and Xi Lei powder (OR = 0.34, 95%CI: 0.13 to 0.81) in reducing tumor necrosis factor and the recurrence rate of UC.

Conclusion: TCM combined with mesalazine is more effective than mesalazine alone in the treatment of UC.

Keywords: Mesalazine; Network meta-analysis; Traditional Chinese medicine; Treatment; Ulcerative colitis.

Figure 1

Screening flow diagram of included studies. CNKI: China National Knowledge Infrastructure; PubMed: Publication Database of the National Library of Medicine; VIP: Chinese Scientific Journal Database.

Figure 2

Bias risk assessment of included studies.

Figure 3

Network meta-analysis. A-E: Network meta-analysis maps of the studies examining the efficacy of five Chinese herbal formulas for adjuvant treatment of ulcerative colitis on clinical efficacy (A), baron points (B), Inflammatory Bowel Disease Questionnaire points (C), tumor necrosis factor (D), and recurrence rate (E). The size of the nodes relates to the number of participants in that intervention type, and the thickness of lines between the interventions relates to the number of studies for that comparison. Chang-yan-ning (CYN), Xi Lei powder, Baitouweng decoction (BTWT), Shenlingbaizhu powder (SLBZS), Shaoyao decoction (SYT) stand for CYN combined with mesalazine, Xileisan combined with mesalazine, BTWT combined with mesalazine, SLBZS combined with mesalazine, and SYT combined with mesalazine, respectively.

Figure 4

Results of network meta-analysis. Bold font indicates statistical significance (P < 0.05). A: Network meta-analysis (NMA) of the clinical efficacy of traditional Chinese medicine (TCM) adjuvant mesalazine in the treatment of ulcerative colitis [UC; OR (95%CI)]; B: NMA of the tumor necrosis factor of TCM adjuvant mesalazine in the treatment of UC [mean difference (MD; 95%CI)]; C: NMA of the Baron points of TCM adjuvant mesalazine in the treatment of UC [MD (95%CI)]; D: NMA of the recurrence rate of TCM adjuvant mesalazine in the treatment of UC [OR (95%CI)]; E: NMA of the Inflammatory Bowel Disease Questionnaire of TCM adjuvant mesalazine in the treatment of UC [MD (95%CI)]. Chang-yan-ning (CYN), Xi Lei powder (XLS), Baitouweng decoction (BTWT), Shenlingbaizhu powder (SLBZS), Shaoyao decoction (SYT) stand for CYN combined with mesalazine, Xileisan combined with mesalazine, BTWT combined with mesalazine, SLBZS combined with mesalazine, and SYT combined with mesalazine, respectively.

Figure 5

Ranking diagram of outcome indicators for each intervention. A: Clinical efficacy; B: Baron points; C: Inflammatory Bowel Disease Questionnaire points; D: Tumor necrosis factor; E: Recurrence rate. Chang-yan-ning (CYN), Xi Lei powder (XLS), Baitouweng decoction (BTWT), Shenlingbaizhu powder (SLBZS), Shaoyao decoction (SYT) stand for CYN combined with mesalazine, Xileisan combined with mesalazine, BTWT combined with mesalazine, SLBZS combined with mesalazine, and SYT combined with mesalazine, respectively.

Figure 6

Funnel plot. A-C: Funnel plots for each outcome indicator with clinical efficacy (A), tumor necrosis factor (B), and recurrence (C). Chang-yan-ning (CYN), Xi Lei powder (XLS), Baitouweng decoction (BTWT), Shenlingbaizhu powder (SLBZS), Shaoyao decoction (SYT) stand for CYN combined with mesalazine, Xileisan combined with mesalazine, BTWT combined with mesalazine, SLBZS combined with mesalazine.