Chinese herbal medicine and COVID-19: quality evaluation of clinical guidelines and expert consensus and analysis of key recommendations

Abstract

Objective:To systematically review the clinical practice guidelines (CPGs) for the treatment of patients with coronavirus disease 2019 (COVID-19) using Chinese herbal medicine (CHM), assess the methodological quality as well as clinical credibility and implementability of specific recommendations, and summarize key recommendations.

Methods:As of April 2022, we conducted a comprehensive search on major electronic databases, guideline websites, academic society websites, and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and Evaluation-Recommendations EXcellence (AGREE-REX) instructions, respectively.

Results:The search yielded 61 CPGs, which were mostly published in 2020; moreover, 98.4% of the CPGs were published in China. Only five CPGs achieved a high-quality AGREE II rating; further, six CPGs could be directly recommended, with most of the CPGs still showing much room for improvement. CPGs had a low overall score in the AGREE-REX evaluation, with the domains of clinical applicability, values and preferences, and implementability being standardized in 21.80%β±β12.56%, 16.00%β±β11.81%, and 31.33%β±β14.55% of the CPGs, respectively. Five high-quality CPGs mentioned 56 Chinese herbal formulas. Half of the recommendations had moderate or strong evidence level in the GRADE evaluation. The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule; however, the strength of recommendation for each prescription varied across CPGs and populations.

Conclusions:The overall quality of current CPGs for COVID-19 for CHM still needs to be improved; moreover, the strength of the evidence remains to be standardized across CPGs.

Keywords

AGREE II / AGREE-REX / Chinese herbal formulations / COVID-19 / Guideline / Quality evaluation

flict of interest statement

The authors declare no conflict of interest.

Funding

None.

Author contributions

Qingyong Zheng and Xiaofeng Luo conceived the manuscript idea. Qingyong Zheng and Ya Gao drafted the manuscript. Qingyong Zheng, Lu Xiong, Hengyi Huang, and Xiaofeng Luo filtered the articles and performed data extraction. Qingyong Zheng, Guoyuan OuYang, Junfen Li, and Wulayin·Saimire evaluated CPGs based on the AGREE II tool. Qingyong Zheng, Hengyi Huang, Jingjing Yang, Yu Zhang, and Xiaopeng Wang evaluated CPGs based on the AGREE-REX tool. Qingyong Zheng analyzed the data and completed the graphs. Xiaofeng Luo provided a critical version of the manuscript. All authors contributed to the revision of the manuscript and approved the final manuscript.

Ethical approval of studies and informed consent

Not applicable.

Acknowledgments

None.

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