Review
Chinese herbal medicine as adjuvant treatment to chemotherapy for multidrug-resistant tuberculosis (MDR-TB): A systematic review of randomised clinical trials
Summary
Introduction
Chinese
herbal medicine (CHM) has been increasingly used as an adjuvant
treatment for multi-drug resistant tuberculosis (MDR-TB) in China. To
inform clinical practice, we performed a systematic review on the
beneficial effect and safety of CHM for MDR-TB.
Methods
We
searched six electronic databases for randomised clinical trials (RCTs)
of CHM for MDR-TB. We used RevMan 5.2 software for data analyses with
effect estimates as risk ratio (RR) with 95% confidence interval (CI).
Results
30
RCTs involving 3374 participants with MDR-TB were included. The
methodological quality was generally poor in terms of risk of bias.
Meta-analyses favoured CHM plus chemotherapy on sputum bacteriological
conversion rate compared with chemotherapy alone after initiation of
treatment (6th mos: RR 1.27, 95% CI 1.14 to 1.41, n = 12; 12th mos: RR
1.30, 95% CI 1.11 to 1.52, n = 6; 18th mos: RR 1.19, 95% CI 1.11 to
1.27, n = 9). Compared with chemotherapy alone, meta-analyses showed
benefit from CHM plus chemotherapy on lung lesions resorption rate (6th
mos: RR 1.10, 95% CI 0.91 to 1.32, n = 5; 12th mos: RR 1.26, 95% CI 1.10
to 1.45, n = 4; 18th mos: RR 1.19, 95% CI 1.08 to 1.32, n = 7) and
cavity closure rate (12th mos: RR 1.48, 95% CI 1.06 to 2.07, n = 2; 18th
mos: RR 1.26, 95% CI 1.04 to 1.53, n = 5), relapse rate (RR 0.28, 95%
CI 0.16 to 0.50, n = 4), and abnormal liver function (RR 0.56, 95% CI
0.46 to 0.69, n = 14). No serious adverse effects were reported.
Conclusions
CHM
as an adjuvant to anti-TB chemotherapy may have beneficial effect for
MDR-TB in terms of bacteriological and radiological outcomes, and is
relatively safe. However, due to poor methodological reporting of the
included trials, a confirmative conclusion needs to be supported by
further robust clinical trials.
Keywords
- Chinese herbal medicine;
- Multidrug resistant tuberculosis;
- Systematic review;
- Meta-analysis;
- Randomised clinical trials
- Corresponding
author. Centre for Evidence-Based Chinese Medicine, Beijing University
of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing
100029, China. Tel.:
+86 10 64287002; fax: +86 10 64286871.
Copyright © 2015 Elsevier Ltd. All rights reserved.