The efficacy of Chinese herbal drugs for adults with angina pectoris: Bayesian network meta-analysis of 331 RCTs involving 36,467 individuals

• Published in: Journal of ethnopharmacology Vol. 326; p. 117925
• Main Authors: Jia, Yongliang, Leung, Siu-wai
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 23-05-2024
• Subjects: Angina pectoris; Bayesian network meta-analysis; Chinese herbal drugs; Randomized controlled trials; Chinese herbal drugs; Angina pectoris; Bayesian network meta-analysis; Randomized controlled trials
• ISSN: 0378-8741; 1872-7573
• DOI: 10.1016/j.jep.2024.117925

Hundreds of randomized controlled trials (RCT) on Chinese herbal drugs (CHDs) including Shexiang baoxin pill (BXP), compound Danshen dripping pill (DSP), compound Danshen tablet (DST), Suxiao jiuxin pill (JXP), Naoxintong capsule (NXT), Tongxinluo capsule (TXL), and Di'ao xinxuekang capsule (XXK) and conventional chemical drugs, such as isosorbide dinitrate (ISDN), for angina pectoris are available but have not been evaluated by a PRISMA-compliant network meta-analysis (NMA).
This study aimed to compare the efficacy of nine anti-anginal drugs through NMA on RCTs.
RCTs of drug treatment for adult patients with angina pectoris for improvements in symptoms and electrocardiography were retrieved. Odds ratios and 95% credible intervals were computed to measure effect sizes. RCT quality was evaluated with the Cochrane risk of bias tool. Evidence synthesis was performed with Bayesian NMA. Essential analyses including subgroup analysis, sensitivity analysis, meta-regression analysis, publication bias analysis, and ranking analysis were conducted to assess the robustness of efficacies. Evidence strength was assessed with the GRADE approach.
A total of 331 RCTs with 36,467 participants were eligible. The overall quality of all included RCTs was low. Overall efficacy estimates from different approaches of evidential synthesis found that BXP, TXL, and DSP were more efficacious than DST and ISDN. Essential analyses indicated consistent efficacy estimates, insignificant publication bias, and corroborative ranking results. The overall GRADE evidence strength was low.
This comprehensive Bayesian NMA found BXP, TXL, and DSP to be the top three candidates among the seven tested CHDs for treating adults suffering from angina pectoris. However, the quality and the evidence strength of eligible RCTs were low. Further high-quality RCTs with more outcome measures and their NMAs are warranted.
PROSPERO CRD42014007035.
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•This study is the first comprehensive PRISMA-compliant Bayesian NMA of Chinese herbal drugs (CHDs) for angina pectoris.•This study provided the latest evidence of CHDs for adult patients suffering from angina pectoris.•The tested CHDs were more efficacious than conventional chemical drugs while the quality of included RCTs was low.•BXP, TXL, and DSP were found to be the top three candidates for adult patients with angina pectoris on all evidence.