Evidence base of randomized controlled trials and guideline recommendations of patent Traditional Chinese Medicines for uncomplicated acute lower respiratory tract infections in adults
Evidence base of randomized controlled trials and guideline recommendations of patent Traditional Chinese Medicines for uncomplicated acute lower respiratory tract infections in adults
OBJECTIVE: To compare clinical practice guideline recommendations on the use of oral patent Traditional Chinese Medicines (PTCMs) for uncomplicated acute lower respiratory tract infections (ALRTIs) in adults with the existing evidence using results of a systematic review of randomized controlled trials (RCTs). METHODS: A systematic review on RCTs and a systematic review of current guidelines on orally taken PTCMs for uncomplicated ALRTIs were performed. PubMed, Cochrane Library, EMBASE and four Chinese databases were searched from inception to September 2016 for RCTs testing orally taken PTCMs for uncomplicated ALRTIs (excluding pneumonia). Two reviewers independently screened each study, extracted study data, and assessed risk of bias. Disagreements were resolved through discussion or by consultation with a third reviewer. Clinical practice guidelines for uncomplicated ALRTIs containing PTCM recommendations were identified and quality appraised. The quality of pooled evidence of the RCTs and the guidelines was assessed with GRADE and AGREE Ⅱ respectively. The consistency of the evidence base in RCTs and the guideline recommendations were then compared. RESULTS: For the systematic review of RCTs, 4810 papers were identified, among which 29 RCTs (5093 patients) were included in the review. PTCMs compared to placebo increased the effective treatment rate of cough (3 trials, 949 patients, risk ratio (RR) 2.50, 1.16 to 5.43; low certainty); improved assessment of global health (3 trials, 948 patients, RR 1.70, 1.44 to 2.01; low certainty); and increased the effective rate of specific symptom relief (1 trial, 478 patients, RR 4.01, 2.76 to 5.81; moderate certainty). 21 trials (3432 patients) compared effects of different PTCMs. For the guideline evaluation, 29 PTCMs were recommended for the use of uncomplicated ALRTIs, of which27 had no supportive evidence from RCTs. CONCLUSION: The evidence base of PTCMs for uncomplicated ALRTIs is weak and the guideline recommendations were based on almost no clinical trial evidence. Rigorous clinical research is urgently needed to inform the clinical use of these herbal medicines. Further training in evidence-based medicine methods for Traditional Chinese Medicine guideline developers is essential.
Acute lower respiratory tract infections, Antibiotic, Aystematic review, Guideline, Traditional Chinese Medicine
490-503
Xia, Ruyu
394737f7-9ef2-4036-970e-a47eb559b737
Hu, Xiaoyang
65904b24-3775-4b14-9532-eb703a056655
Wang, Di
a5be5c5c-fc2b-407d-b9e3-09deb416533f
Wang, Ying
1569db38-4de9-4288-bd74-e7c0ed4b4d69
Willcox, Merlin
dad5b622-9ac2-417d-9b2e-aad41b64ffea
Liu, Jianping
4699004b-2872-49f2-b2f9-f90a061a29db
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Flower, Andrew
6cbf5d07-c3ed-4d3a-a474-9c8b19a97a9c
Li, Xun
393ace3b-1536-4e4f-ba57-436c63cf1c79
Lai, Lily
4ad55f3d-3e0c-4faa-a981-cbbbb4319811
Hu, Ruixue
9529009f-d3c1-4325-bd0e-c388e39055bd
Wen, Lingzi
f64ca9b5-7bee-4e15-ba83-f8214c9f72f8
Zhang, Lishan
49832982-cf3d-4531-8342-0c648b41e6c9
Wang, Qi
91220429-39a1-459a-9dfb-20fb90bfa974
Fei, Yutong
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15 August 2018
Xia, Ruyu
394737f7-9ef2-4036-970e-a47eb559b737
Hu, Xiaoyang
65904b24-3775-4b14-9532-eb703a056655
Wang, Di
a5be5c5c-fc2b-407d-b9e3-09deb416533f
Wang, Ying
1569db38-4de9-4288-bd74-e7c0ed4b4d69
Willcox, Merlin
dad5b622-9ac2-417d-9b2e-aad41b64ffea
Liu, Jianping
4699004b-2872-49f2-b2f9-f90a061a29db
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Flower, Andrew
6cbf5d07-c3ed-4d3a-a474-9c8b19a97a9c
Li, Xun
393ace3b-1536-4e4f-ba57-436c63cf1c79
Lai, Lily
4ad55f3d-3e0c-4faa-a981-cbbbb4319811
Hu, Ruixue
9529009f-d3c1-4325-bd0e-c388e39055bd
Wen, Lingzi
f64ca9b5-7bee-4e15-ba83-f8214c9f72f8
Zhang, Lishan
49832982-cf3d-4531-8342-0c648b41e6c9
Wang, Qi
91220429-39a1-459a-9dfb-20fb90bfa974
Fei, Yutong
38d05d9e-30d7-48b4-b86d-768abefede0c
Xia, Ruyu, Hu, Xiaoyang, Wang, Di, Wang, Ying, Willcox, Merlin, Liu, Jianping, Moore, Michael, Flower, Andrew, Li, Xun, Lai, Lily, Hu, Ruixue, Wen, Lingzi, Zhang, Lishan, Wang, Qi and Fei, Yutong
(2018)
Evidence base of randomized controlled trials and guideline recommendations of patent Traditional Chinese Medicines for uncomplicated acute lower respiratory tract infections in adults.
Journal of Traditional Chinese Medicine, 38 (4), .
Abstract
OBJECTIVE: To compare clinical practice guideline recommendations on the use of oral patent Traditional Chinese Medicines (PTCMs) for uncomplicated acute lower respiratory tract infections (ALRTIs) in adults with the existing evidence using results of a systematic review of randomized controlled trials (RCTs). METHODS: A systematic review on RCTs and a systematic review of current guidelines on orally taken PTCMs for uncomplicated ALRTIs were performed. PubMed, Cochrane Library, EMBASE and four Chinese databases were searched from inception to September 2016 for RCTs testing orally taken PTCMs for uncomplicated ALRTIs (excluding pneumonia). Two reviewers independently screened each study, extracted study data, and assessed risk of bias. Disagreements were resolved through discussion or by consultation with a third reviewer. Clinical practice guidelines for uncomplicated ALRTIs containing PTCM recommendations were identified and quality appraised. The quality of pooled evidence of the RCTs and the guidelines was assessed with GRADE and AGREE Ⅱ respectively. The consistency of the evidence base in RCTs and the guideline recommendations were then compared. RESULTS: For the systematic review of RCTs, 4810 papers were identified, among which 29 RCTs (5093 patients) were included in the review. PTCMs compared to placebo increased the effective treatment rate of cough (3 trials, 949 patients, risk ratio (RR) 2.50, 1.16 to 5.43; low certainty); improved assessment of global health (3 trials, 948 patients, RR 1.70, 1.44 to 2.01; low certainty); and increased the effective rate of specific symptom relief (1 trial, 478 patients, RR 4.01, 2.76 to 5.81; moderate certainty). 21 trials (3432 patients) compared effects of different PTCMs. For the guideline evaluation, 29 PTCMs were recommended for the use of uncomplicated ALRTIs, of which27 had no supportive evidence from RCTs. CONCLUSION: The evidence base of PTCMs for uncomplicated ALRTIs is weak and the guideline recommendations were based on almost no clinical trial evidence. Rigorous clinical research is urgently needed to inform the clinical use of these herbal medicines. Further training in evidence-based medicine methods for Traditional Chinese Medicine guideline developers is essential.
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Full text-2018-7-23 Eviden based of rct and guideline rec of patent TCM
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Xia et al 2018 Journal of Traditional Chinese Medicine August 2018
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Accepted/In Press date: 31 March 2018
e-pub ahead of print date: 15 August 2018
Published date: 15 August 2018
Additional Information:
Funding Information:
Chinese Medicine, Beijing University of Chinese Medicine, Beijing100029,China Hu Xiao-Y ang , Merlin W illc o x, Michael Moore, Andrew Flower , Lily Lai, Primary Care and P opula tion Sciences, Uni-versityofSouthampton,SouthamptonSO165ST ,UK Zhang Lishan, Respiratory Department, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing100700,China W ang Qi, Respiratory Department, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078,China Supported by the F undamen tal Research F unds for the CentralUniversities(BeijingUniversityofChineseMedicine, No . 2017-JYB-JS-149); the F undamen tal Research F unds for theCentralUniversities(BeijingUniversityofChineseMedi-cine, No . 2017-JYB-XS-023); Beijing Nova Program (No . Z111107054511086);BeijingUniversityofChineseMedicine Research Development Project (No . 2016-ZXFZJJ-011), and Capacity Building In Evidence-based Chinese Medicine and Internationalization Project (No . 1000061020008) Correspondence to: Dr . F ei Y ut ong, Centre for Evidence-Based Chinese Medicine, Beijing University of Chi-neseMedicine,Beijing100029,China.yutong_fei@163.com T elephone: +86-13810644761 Accepted:March31,2018
Funding Information:
Supported by the Fundamental Research Funds for the Central Universities (Beijing University of Chinese Medicine, No. 2017-JYB-JS-149); the Fundamental Research Funds for the Central Universities (Beijing University of Chinese Medicine, No. 2017-JYB-XS-023); Beijing Nova Program (No. Z111107054511086); Beijing University of Chinese Medicine Research Development Project (No. 2016-ZXFZJJ-011), and Capacity Building In Evidence-based Chinese Medicine and Internationalization Project (No. 1000061020008).
Publisher Copyright:
© 2018 JTCM. All rights reserved.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Keywords:
Acute lower respiratory tract infections, Antibiotic, Aystematic review, Guideline, Traditional Chinese Medicine
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Local EPrints ID: 425104
URI: http://eprints.soton.ac.uk/id/eprint/425104
ISSN: 0255-2922
PURE UUID: aed92d46-6a86-4595-a5a4-7a7ce494ba48
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Date deposited: 10 Oct 2018 16:30
Last modified: 18 Mar 2024 05:20
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Contributors
Author:
Ruyu Xia
Author:
Di Wang
Author:
Ying Wang
Author:
Jianping Liu
Author:
Andrew Flower
Author:
Xun Li
Author:
Ruixue Hu
Author:
Lingzi Wen
Author:
Lishan Zhang
Author:
Qi Wang
Author:
Yutong Fei
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