Comparative effectiveness of ten CPMs for acute exacerbation of chronic obstructive pulmonary disease: systematic review and network meta-analysis

TL;DR

This study compares ten Chinese patent medicines for treating acute COPD flare-ups in China, finding some may improve lung function and reduce inflammation.

Contribution

A network meta-analysis of ten Chinese patent medicines for AECOPD, identifying their comparative effectiveness and safety profiles.

Findings

ZCL showed the highest total effective rate improvement for AECOPD.

SWLDH was most effective for improving FVC and FEV1 lung function parameters.

CPMs did not significantly increase adverse events compared to standard care.

Abstract

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a prevalent acute respiratory disease in China, necessitating effective treatments.

To investigate the therapeutic and safety profiles of Chinese patent medicines (CPMs) for AECOPD.

Randomized controlled trials (RCTs) investigating CPMs for AECOPD were retrieved from PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wanfang, and CBM. Reviewers independently conducted study selection, data extraction, and bias risk using the Cochrane RoB 2.0. The principal endpoints included total effective rate and pulmonary function parameters; secondary endpoints comprised arterial blood gas indices, inflammatory markers, and adverse events. A frequentist-based analytical strategy was utilized, with StataSE 18.0 for analysis.

84 RCTs comprising 8,477 participants and 10 CPMs were included. ZCL showed the greatest improvement in total effective rate (RR 4.26, 95% CI 2.24–8.09; SUCRA 72.4%). SWLDH ranked highest for FVC (MD 0.58, 95% CI 0.29–0.87; SUCRA 94.5%) and FEV1 (MD 0.85, 95% CI 0.56–1.15; SUCRA 98.0%). QKL demonstrated the most significant effect on FEV1/FVC (MD 8.57, 95% CI 3.80–13.34; SUCRA 87.0%) and also ranked first for pH. XZL was superior in PaO2 and IL-6, while RDN best reduced PaCO2 and IL-8. QQHT was most effective for TNF-α. The analysis found no statistically significant increase in the risk of adverse events for any CPM + CT, compared to CT alone. The level of evidence certainty was categorized as low or very low.

CPMs may improve total effective rate, pulmonary function, blood gas parameters, and inflammatory markers in AECOPD. However, these findings require confirmation by high-quality studies.

[https://www.crd.york.ac.uk/PROSPERO/view/], identifier [CRD420251059887].

Comparative effectiveness of ten CPMs for AECOPD.A graphic abstract detailing a systematic review and network meta-analysis on the effectiveness of ten CPMs for acute exacerbation in COPD patients. The methods section shows the use of the PROSPERO protocol and RCT design involving 585 studies from various databases. Results indicate study characteristics with 84 RCTs involving 8477 participants. Meta-analysis tools such as risk of bias charts, SUCRA line plots, network, forest plots, and league tables are included. The conclusion emphasizes the effectiveness of specific CPMs like ZCL in clinical improvement and RDN in reducing inflammatory markers.

Comparative effectiveness of ten CPMs for AECOPD.

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