Chinese herbal medicine as adjuvant treatment to chemotherapy for multidrug-resistant tuberculosis (MDR-TB): a systematic review of randomised clinical trials

摘要

Purpose: Chinese herbal medicine (CHM) has been increasinglyused as an adjuvant treatment for multi-drug resistanttuberculosis (MDR-TB) in China. To inform clinical practice,we performed a systematic review on the beneficial effect andsafety of CHM for MDR-TB.Methods: We systematically searched the six electronicdatabases for randomised clinical trials (RCTs) of CHM pluschemotherapy for MDR-TB. RevMan 5.2 software was used fordata analyses with effect estimates presented as risk ratio (RR)with 95% confidence interval (CI).Results: 28 RCTs involving 3085 participants with MDRTBwere included. The methodological quality was generallypoor in terms of risk of bias. Meta-analyses favoured CHMplus chemotherapy on sputum bacteriological conversion ratecompared with chemotherapy alone after initiation of treatment(6th months: RR 1.29, 95% CI 1.14 to 1.46, n=11; 12thmonths: RR 1.38, 95% CI 1.19 to 1.59, n=5; 18th months: RR 1.19,95% CI 1.11 to 1.28, n=7). Compared with chemotherapy alone,meta-analysis showed benefit from CHM plus chemotherapyon lung lesions absorption rate (12th months: RR 1.26, 95% CI1.09 to 1.46, n=3; 18th months: RR 1.18, 95%CI 1.07 to 1.30, n=6)and pulmonary cavity closure rate by radiological examination(18th months: RR 1.24, 95%CI 1.01 to 1.51; n=4), relapse rate (RR0.28, 95%CI 0.16 to 0.50, n=4), and abnormal liver function (RR0.56, 95% CI 0.46 to 0.69, n=14).Conclusion: CHM as an adjuvant to anti-TB chemotherapymay have beneficial effect for MDR-TB in terms of bacteriologicaland radiological outcomes, and is safe. However, due topoor methodology of the included trials, a confirmative conclusionneeds to be supported through further robust clinicaltrial.