The effects of Chinese herbal medicines on Madopar dose and adverse reaction during the maintenance phase of Parkinson's disease:a systematic review with meta-analysis

摘要

Background:Parkinson’s disease is a progressive neurodegenerative disease,and is usually treated with levodopa combined with dopa decarboxylase inhibitor like Madopar.In order to improve the efficacy and reduce adverse reactions,Chinese herbal medicines are usually applied with Madopar to treat Parkinson’s disease in clinic.According to the results of certain randomized controlled trials,levodopa drugs combined with Chinese herbal medicines could achieve better effects like the improvement of clinical symptoms,the reduced incidence of adverse reactions,and the reduced dose of levodopa drugs(especially in the maintenance phase).However,not all the randomized controlled trials showed favorable effect on Parkinson’s disease.Therefore,it is necessary to find out how to effectively combine Chinese herbal medicines with Madopar.In order to evaluate the effects of Chinese herbal medicines on Madopar dose and adverse reaction during the maintenance phase of Parkinson’s disease,a meta-analysis was conducted.Methods:A systematic research was carried out for randomized controlled trials of combined Chinese herbal medicines and Madopar treatment for Parkinson’s disease during the maintenance phase published till August 2019.The primary outcome was the Madopar dose and secondary outcome was the incidence of adverse reaction.Data were pooled and analyzed with RevMan 5.3.Results:A total of 18 studies were included with 1,169 cases.However,study quality evaluation showed low methodological quality.Meta-analyses showed that the dose of Madopar in the treatment group was significantly lower than that in the control group,and the incidence of adverse reactions in the treatment group was also significantly lower than that in the control group.However,the correlation analysis showed that the reduction of Madopar dose was not related to the reduction of incidence of adverse reactions(P>0.05).There existed publication bias on the primary outcome and secondary outcome.Conclusions:Chinese herbal medicines could reduce the Madopar dose and adverse reaction during the maintenance phase of Parkinson’s disease treatment.This conclusion must be considered cautiously,for lack of studies of high quality.