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. 2024 Sep 26:15:1434764.
doi: 10.3389/fphar.2024.1434764. eCollection 2024.

Updated evidence of the Naoshuantong capsule against ischemic stroke: a systematic review and meta-analysis of randomized controlled trials

Cuilin Que #  1   2   3 , Yupeng Wei #  1   2   3 , Guanxiang Yin  3 , Congren Zhou  1   2   3 , Zhenhong Liu  1   2 , Xinxing Lai  1   2 , Mingzhen Qin  1   2   3 , Xuejiao Xiong  1   2   3 , Xiangyi Zheng  1   3 , Xinglu Dong  1   2 , Ying Gao  1   2   4
Affiliations

Updated evidence of the Naoshuantong capsule against ischemic stroke: a systematic review and meta-analysis of randomized controlled trials

Cuilin Que et al. Front Pharmacol. .

Abstract

Background: Stroke is a serious health issue that can result in death or disability, leading to a significant economic strain on society and families. A growing number of studies have shown that the Naoshuantong capsule (NSTC) is beneficial as a treatment for ischemic stroke (IS) in recent years. Our study aims to provide an update on the safety and efficacy of the NSTC in IS patients.

Methods: We thoroughly searched eight databases to identify suitable randomized controlled trials (RCTs) assessing the effectiveness of the NSTC in the treatment of IS. The National Institute of Health Stroke Scale (NIHSS) for an acute period and modified Rankin Scale (mRS) at 3 months for a non-acute period were considered the primary outcome, and secondary outcomes included the NIHSS for a non-acute period, mRS, Barthel Index (BI), modified Barthel Index (MBI), Stroke-specific Quality of life (SS-QOL), and the recurrence rate of cerebrovascular events. Subsequently, its quality was assessed using the Cochrane risk assessment scale. Statistical analysis was conducted using RevMan 5.3 and Stata 14.0.

Results: A total of 27 RCTs were included, which involved 3,139 patients. The results showed that the NSTC improved neurological function not only in the acute period (MD = -2.53; 95% CI: -2.91, -2.15; p < 0.00001) but also in the non-acute period (MD = -3.70; 95% CI: -5.82, -1.58; p = 0.0006) and improved the long-term functional outcomes with lower mRS scores (MD = -0.68; 95% CI: -1.09, -0.26; p = 0.001). At the same time, the NSTC decreased the risk of cerebrovascular disease recurrence (RR = 0.43; 95% CI: 0.27, 0.70; p = 0.0006) and increased the quality of life in the acute period (MD = 23.88; 95% CI: 16.63, 31.13; p < 0.00001). Significant disparities in the incidence of adverse events between the NSTC and control groups were not observed. The certainty of evidence was estimated as moderate to very low.

Conclusion: The NSTC emerges as a potentially efficacious and safe treatment option for IS. NSTC could improve neurological function in different period of IS, and it has certain clinical value in secondary prevention. As a result of the poor quality and heterogeneity of the included trials, larger and standardized RCTs are needed to validate NSTC in IS treatment.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=482981, identifier CRD42023482981.

Keywords: Chinese patent medicine; Naoshuantong capsule; ischemic stroke; meta-analysis; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of study selection.
FIGURE 2
FIGURE 2
Risk of bias graph.
FIGURE 3
FIGURE 3
Forest plot of the acute period of the NIHSS.
FIGURE 4
FIGURE 4
Forest plot of the non-acute period of the NIHSS.
FIGURE 5
FIGURE 5
Forest plot of the mRS.
FIGURE 6
FIGURE 6
Forest plot of the BI.
FIGURE 7
FIGURE 7
Forest plot of the mBI.
FIGURE 8
FIGURE 8
(A) Forest plot of SS-QOL at 14 days. (B) Forest plot of SS-QOL at 180 days.
FIGURE 9
FIGURE 9
Forest plot of the recurrence rate of cerebrovascular events.
FIGURE 10
FIGURE 10
Forest plot of the AE.
FIGURE 11
FIGURE 11
(A) Funnel plots of the NlHSS (acute period). (B) Funnel plots of the Bl. (C) Funnel plots of the AE.
FIGURE 12
FIGURE 12
Potential mechanism of the NSTC.
See this image and copyright information in PMC

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