An umbrella review of Lianhua Qingwen combined with Western medicine for the treatment of coronavirus disease 2019

Abstract

Objective:Lianhua Qingwen combined with Western medicine (LHQW+WM) has been proposed as a viable treatment for coronavirus disease 2019 (COVID-19). Interestingly, umbrella reviews of systematic reviews (SRs), which provide the most comprehensive evidence, are the best evidence in evidence-based medicine. Therefore, an umbrella review of SRs that summarizes and evaluates the efficacy of LHQW+WM for COVID-19 is urgently required. Methods: Overall, 6 databases were used to conduct a comprehensive literature search from inception to January 22, 2022. The corrected covered area (CCA) was used to analyze the overlapping between SRs. Meta-analysis was conducted when that of the included SRs was inappropriate. A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2) was also employed to assess the quality of the included SRs. Results:In total, 12 SRs were identified, which included 12 unique primary studies. The included SRs ranged in quality from moderate to critically low and had an extremely high CCA (36.4%). Compared to conventional treatment, LHQW+WM showed efficacy concerning fatigue recovery[risk ratio (RR) = 1.69, 95% confidence interval (CI): 1.04-2.73, n = 2, I² = 0%], cough recovery (RR = 1.65, 95% CI: 1.09-2.51, n = 3, I² = 39.1%), and overall effective rates (RR = 1.17, 95% CI: 1.07-1.28, n = 3, I² = 17.5%). Conclusion: LHQW+WM may improve the clinical symptoms of patients with COVID-19; however, the results should be interpreted cautiously because of the rigorous processes in the included SRs.

Keywords

COVID-19 / Lianhua Qingwen / Meta-analysis / Umbrella review

References

[[1]] World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int/.

[[2]] Zhang BL.Acupuncture and herbal medicine launched: building a bridge between traditional and modern medicine. Acupunct Herb Med. 2021;1:1-2.

[[3]] Da XL, Yue LF, Li XJ, et al.Potential therapeutic effect and methods of traditional Chinese medicine on COVID-19-induced depression: a review. Anat Rec (Hoboken). 2021;304:2566-2578.

[[4]] Danhieux K, Buffel V, Pairon A, et al.The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium. BMC Fam Pract. 2020;21:255.

[[5]] Elavarasan RM, Pugazhendhi R, Shafiullah GM, et al.Impacts of COVID-19 on sustainable development goals and effective approaches to maneuver them in the post-pandemic environment. Environ Sci Pollut Res Int. 2022;29:33957-33987.

[[6]] Burki TK.The role of antiviral treatment in the COVID-19 pandemic. Lancet Respir Med. 2022;10:e18.

[[7]] Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for oral treatment of Covid-19 in nonhospitalized patients. N Engl [J] Med. 2021;386:509-520.

[[8]] Centers for Disease Control and Prevention. Clinical Course: Progression, Management, and Treatment. 2022. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/clinical-considerations-course.html.

[[9]] China Daily. 6 effective TCM recipes for COVID-19.2020. Available from: https://covid-19.chinadaily.com.cn/a/202003/24/WS5e795bb6a3101282172816c2.html.

[[10]] Lyu M, Fan G, Xiao G, et al. Traditional Chinese medicine in COVID-19. Acta Pharm Sin B. 2021;11:3337-3363.

[[11]] Jin GY, Jin LL, Jin BX.The rationale behind the four major anti-COVID-19 principles of Chinese herbal medicine based on systems medicine. Acupunct Herb Med. 2021;1:90-98.

[[12]] Huang K, Zhang P, Zhang ZH, et al. Traditional Chinese medicine (TCM) in the treatment of COVID-19 and other viral infections: efficacies and mechanisms. Pharmacol Ther. 2021;225:107843.

[[13]] Teo CS, Tan PM, Shu CSI, et al.Challenges and strategies for implementing Chinese medicine during COVID-19 in Malaysia. Integr Med Res. 2021;10:100783.

[[14]] Chen XF, Wu YL, Chen C, et al. Identifying potential anti-COVID-19 pharmacological components of traditional Chinese medicine Lianhuaqingwen capsule based on human exposure and ACE2 biochromatography screening. Acta Pharm Sin B. 2021;11:222-236.

[[15]] Yang M, Jiang L, Wang Q, et al. Traditional Chinese medicine for knee osteoarthritis: an overview of systematic review. PLoS One. 2017;12:e0189884e0189884.

[[16]] Sun CY, Zhang HR, Liu XY, et al.Umbrella review: evidence-based practice for selecting and applying the best synthesis of evidence. Chin[J] Evid-Based Med. 2022;22:609-614.

[[17]] Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

[[18]] Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev.2019;10:ED000142.

[[19]] Shea BJ, Reeves BC, Wells G, et al.AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.

[[20]] Pieper D, Antoine S-L, Mathes T, et al.Systematic review finds overlapping reviews were not mentioned in every other overview.[J] Clin Epidemiol. 2014;67:368-375.

[[21]] Hennessy EA, Johnson BT.Examining overlap of included studies in meta-reviews: guidance for using the corrected covered area index. Res Synth Methods. 2020;11:134-145.

[[22]] Liu M, Gao Y, Yuan Y, et al. Efficacy and safety of herbal medicine (Lianhuaqingwen) for treating COVID-19: a systematic review and meta-analysis. Integr Med Res. 2021;10:100644.

[[23]] Fan Z, Guo GM, Che XP, et al.Efficacy and safety of Lianhuaqingwen for mild or moderate coronavirus disease 2019: a meta-analysis of randomized controlled trials. Medicine. 2021;100:e26059.

[[24]] Hu CY, Liang MM, Gong FF, et al.Efficacy of Lianhua Qingwen compared with conventional drugs in the treatment of common pneumonia and COVID-19 pneumonia: a meta-analysis. MedEvid-Based Complement Alternat. 2020;2020:5157089.

[[25]] Zhuang JQ, Dai XZ, Wu QH, et al. A meta-analysis for Lianhua Qingwen on the treatment of coronavirus disease 2019 (COVID-19). Complement Ther Med. 2021;60:102754.

[[26]] Wang DC, Yu M, Xie WX, et al.Meta-analysis on the effect of combining Lianhua Qingwen with Western medicine to treat coronavirus disease 2019. [J] Integr Med. 2022;20:26-33.

[[27]] Zeng MJ, Li LJ, Wu ZQ. Traditional Chinese medicine Lianhua Qingwen treating corona virus disease 2019(COVID-19): meta-analysis of randomized controlled trials. PLoS One. 2020;15:e0238828.

[[28]] Qi GD, Qi W, Jiang Q, et al.The efficacy of Lianhua Qingwen combined with Western medicine scheme on COVID-19 general type patients: a systematic review. Clinical [J] Tradit Chin Med. 2020;32:1195-1199.

[[29]] Zhang WB, Liu LN, Wang Z, et al.Meta-analysis of the efficacy and safety of Lianhua Qingwen combined with Western medicine in the treatment of common patients with new coronary pneumonia. [J] Hainan Med Univ. 2020;26:1045-1050.

[[30]] Wang SX, Li MY, Chen XL, et al.Clinical efficacy of Lianhua Qingwen integrated with Western medicine on COVID-19 by meta-analysis. Chin Tradit Herb Drugs. 2020;51:3763-3769.

[[31]] Tang YL, Wang JM, Yang C, et al.Meta-analysis of the efficacy of Lianhua Qingwen on COVID-19. Tianjin [J] Tradit Chin Med. 2021;38:1414-1420.

[[32]] Zhang HY, Wu JY, Sun L, et al.Meta analysis and trial sequential analysis of Lianhua Qingwen treating COVID. Prac J Med & Pharm. 2020;37:1110-1114.

[[33]] Yang M, Yang SH, Yang M, et al.Systematic review on the treatment of novel coronavirus pneumonia with Chinese Herbal Lianhua Qingwen. Chin [J] Drug Evaluation. 2020;37:126-130.

[[34]] Cheng DZ, Wang WJ, Li Y, et al.51 cases of COVID-19 patients with Chinese medicine Lianhuaqingwen curative effect analysis: a multi-center retrospective study. Tianjin [J] Tradit Chin Med. 2020;37:509-516.

[[35]] Cheng DZ, Li Y.Clinical effectiveness and case analysis in 54 NCP patients treated with Lanhuaqingwen granules. World Chin Med. 2020;15:150-154.

[[36]] Hu K, Guan WJ, Bi Y, et al.Efficacy and safety of Lianhuaqingwen capsules, a repurposed Chinese herb, in patients with coronavirus disease 2019: a multicenter, prospective, randomized controlled trial. Phytomedicine. 2020;85:153242.

[[37]] Liu LL, Yuan LF, Feng Y, et al. Clinical study on combined scheme of Lianhuaqingwen capsules and abidole in the treatment for coronavirus disease 2019. Guangdong Med J. 2020;41:1207-1210.

[[38]] Lyu RB, Wang WJ, Li X.Clinical observation of Lianhua Qingwen granules combined with conventional western medicine in the treatment of 63 suspected cases of novel coronavirus pneumonia. [J] Tradit Chin Med. 2020;61:655-659.

[[39]] Shi J, Yang ZG, Ye C, et al.Clinical observation on 49 cases of non-critical COVID-19 in Shanghai treated by integrated traditional Chinese and western medicine. Shanghai [J] Tradit Chin Med. 2020;54:30-35.

[[40]] Sun HM, Xu F, Zhang L, et al.Study on clinical efficacy of Lianhua Qingke granule in treatment of mild and ordinary COVID-19. Chin [J] ETMF. 2020;26:29-34.

[[41]] Wang FC, Shen BX, He CY, et al.Clinical efficacy and mechanism of Lianhua Qingwen granule on COVID-19 based on network pharmacology research. Pharmacol and Clinics Chin Materia Medica. 2020;36:93-101.

[[42]] Wang SZ, Wang HJ, Chen HM, et al.Lianhua Qingwen capsuleand interferon- combined with lopinavir/ritonavir for the treatment of 30 COVID-19 patients. [J] Bengbu Med Coll. 2020;45:154-155.

[[43]] Xia WG, An CQ, Zheng CJ, et al.A clinical study on 34 cases of COVID-19 pneumonia treated with combination of traditional Chinese and western medicines. [J] Tradit Chin Med. 2020;61:375-382.

[[44]] Yao KT, Liu MY, Li X, et al.Retrospective clinical analysis on treatment of coronavirus Disease 2019 with traditional Chinese Medicine Lianhua Qingwen. Chin [J] ETMF. 2020;26:8-12.

[[45]] Yu P, Li YZ, Wan SB, et al. Observation of therapeutic effect of Lianhuaqingwen granule combined with Abidor on mild COVID-19. Chin Pharm J. 2020;55:1042-1045.

[[46]] Siontis KC, Ioannidis JPA.Replication, duplication, and waste in a quarter million systematic reviews and meta-analyses. Circ Cardiovasc Qual Outcomes. 2018;11:e005212.

[[47]] Page MJ, McKenzie JE, Forbes A. Many scenarios exist for selective inclusion and reporting of results in randomized trials and systematic reviews. [J] Clin Epidemiol. 2013;66:524-537.