Efficacy and safety of chinese herbal medicine for treating mild or moderate COVID-19: A systematic review and meta-analysis of randomized controlled trials and observational studies
Zhu, Hongfei
Li, Mengting
Tian, Chen
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Lai, Honghao
Zhang, Yuqing
Shi, Jiaheng
Shi, Nannan
Zhao, Hui
Yang, Kehu
Shang, Hongcai
Sun, Xin
Liu, Jie
Ge, Long
Huang, Luqi
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Ge, L (通讯作者)，Lanzhou Univ, Sch Publ Hlth, Dept Social Med & Hlth Management, Lanzhou, Peoples R China.;Ge, L (通讯作者)，Lanzhou Univ, Sch Publ Hlth, Evidence Based Social Sci Res Ctr, Lanzhou, Peoples R China.;Liu, J; Huang, LQ (通讯作者)，China Acad Chinese Med Sci, China Ctr Evidence Based Tradit Chinese Med, Beijing, Peoples R China.;Ge, L (通讯作者)，WHO Collaborating Ctr Guideline Implementat & Kno, Lanzhou, Peoples R China.;Ge, L (通讯作者)，Key Lab Evidence Based Med & Knowledge Translat G, Lanzhou, Peoples R China.;Sun, X (通讯作者)，Sichuan Univ, West China Hosp, Chinese Evidence Based Med Ctr, Chengdu, Peoples R China.;Liu, J (通讯作者)，China Acad Chinese Med Sci, Guang Anmen Hosp, Dept Oncol, Beijing, Peoples R China.;Huang, LQ (通讯作者)，China Acad Chinese Med Sci, Natl Resource Ctr Chinese Mat Med, Beijing, Peoples R China.
Background: The coronavirus disease 2019 (COVID-19) is still a pandemic globally, about 80% of patients infected with COVID-19 were mild and moderate. Chinese herbal medicine (CHM) has played a positive role in the treatment of COVID-19, with a certain number of primary studies focused on CHM in managing COVID-19 published. This study aims to systematically review the currently published randomized controlled trials (RCTs) and observational studies (OBs), and summarize the effectiveness and safety of CHM in the treatment of mild/moderate COVID-19 patients. Methods: We searched 9 databases up to 19 March 2022. Pairs of reviewers independently screened literature, extracted data and assessed risk of bias. For overall effect, we calculated the absolute risk difference (ARD) of weighted averages of different estimates, and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Results: We included 35 RCTs and 24 OBs enrolling 16,580 mild/moderate patients. The certainty of evidence was very low to low. Compared with usual supportive treatments, most effect estimates of CHM treatments were consistent in direction. CHMs presented significant benefits in reducing rate of conversion to severe cases (ARD = 99 less per 1000 patients in RCTs and 131 less per 1000 patients in OBs, baseline risk: 16.52%) and mortality (ARD = 3 less per 1000 patients in RCTs and OBs, baseline risk: 0.40%); shortening time to symptom resolution (3.35 days in RCTs and 2.94 days in OBs), length of hospital stay (2.36 days in RCTs and 2.12 days in OBs) and time to viral clearance (2.64 days in RCTs and 4.46 days in OBs); increasing rate of nucleic acid conversion (ARD = 73 more per 1000 patients in OBs, baseline risk: 16.30%). No serious adverse reactions were found and the differences between CHM and usual supportive care were insignificant. Conclusion: Encouraging evidence showed that CHMs were beneficial in treating mild or moderate patients. CHMs have been proved to possess a safety profile that is comparable to that of usual supportive treatment alone. More rigorously designed clinical trials and mechanism studies are still warranted to further confirm the present findings.
