Clinical Efficacy and Safety of Xinmailong Injection for the Treatment of Chronic Heart Failure: A Meta-Analysis

Abstract

Background: Chronic heart failure (CHF) is one of the most stubborn cardiovascular disease. Xinmailong (XML), a bioactive fraction extracted from Periplaneta americana L., has been commonly used for CHF treatment in China. However, there is few comprehensive evaluation for the clinical efficacy and safety of XML for CHF.Objectives: We aimed to evaluate the beneficial and adverse effects of Xinmailong Injection (XMLI) on CHF treatment with the use of meta-analysis.Methods: In accordance with the Cochrane Handbook and transparent reporting of systematic reviews and meta-analysis protocol (CRD42018087091), seven English and Chinese electronic databases, including PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Wanfang database, VIP medicine information system and China Biomedical Literature Database (CBM), were searched to retrieve potential randomized controlled trials (RCTs) before November 2017. The eligible trials were evaluated for methodological quality. The main outcome measures were analyzed with RevMan 5.3 software.Results: 26 RCTs involving 3447 participants were subjected to meta-analysis. The total effective rate was improved by XMLI plus conventional therapy (OR 3.10, 95% CI 2.47–3.90, P < 0.00001). When compared to the conventional treatment alone, the combination of XMLI and conventional treatment increased left ventricular ejection fraction (LVEF, MD 4.93, 95% CI 3.96–5.89, P < 0.00001) and 6-min walking distance (6-MWD, MD 46.76, 95% CI 32.51 to 61.01, P < 0.00001), and decreased left ventricular end-diastolic diameter (LVEDD, MD −4.73, 95% CI−5.64 to−3.83, P < 0.00001), serum brain natriuretic peptide (BNP, MD −149.59, 95% CI −211.31 to −87.88, P < 0.00001) and N-terminal pro-brain natriuretic peptide (NT-proBNP, MD −322.35, 95% CI −517.87 to −126.83, P = 0.001). However, the frequency and severity of adverse effects was similar between these two different medications. Poor methodological quality and the limitations also existed in this study.Conclusions: The combinational use of XMLI on conventional treatment may exert better therapeutic effects on improving cardiac function in CHF patients, indicating that XMLI was suggested to be considered during the conventional treatment of CHF. High-quality and large scale RCTs are still required to confirm the impacts of XMLI.

Xinmailong Modulates Platelet Function and Inhibits Thrombus Formation via the Platelet αIIbβ3-Mediated Signaling Pathway

“…(Jiao et al, 2011; Jiao et al, 2012) It has been reported that XML contains four main active ingredients: adenosine, inosine, protocatechuic acid, and pyroglutamate dipeptide ( Figures 1A–D ) (Qi et al, 2017). A series of clinical trials performed in HF patients confirmed the effectiveness of XML in improving cardiac function, such as enhanced myocardial contraction and inhibition of ventricular remodeling (Lu et al, 2018). However, no studies have determined whether XML has anti-platelet or anti-thrombotic effects.…”

Traditional Chinese medicine injections for heart failure: a protocol for systematic review and network meta-analysis of randomised controlled trials

“…Many studies have shown that loading TCMIs based on conventional pharmacotherapy (CPT) can effectively improve the clinical symptoms and reduce the incidence of cardiovascular events and adverse reactions in HF patients. [8][9][10][11][12][13][14][15][16][17] However, due to the lack of direct comparison studies between TCMIs, the comparative results between TCMIs are unclear. Therefore, although the increasing variety of drugs has provided doctors and patients with more choices, meanwhile, it is also a new challenge to choose the best treatment scheme at the same time.…”

Intervention Mechanisms of Xinmailong Injection, a Periplaneta Americana Extract, on Cardiovascular Disease: A Systematic Review of Basic Researches

“…Digitalis drugs may cause poisoning due to the narrow treatment width. Meta-analyses [46][47][48] showed that Xinmailong Injection can significantly improve a variety of clinical indicators related to cardiac function, thereby improving the clinical efficacy of patients with HF. In addition, Xinmailong Injection had the effects of regulating BP, enhancing myocardial contractility, and preventing arrhythmia and thus can prevent the occurrence of the above adverse reactions to a certain extent.…”

“…In addition, Xinmailong Injection had the effects of regulating BP, enhancing myocardial contractility, and preventing arrhythmia and thus can prevent the occurrence of the above adverse reactions to a certain extent. However, Xinmailong Injection combined with conventional treatment of western medicine may cause adverse skin reactions [RR=2.04, 95% CI (1.05, 3.96), P=0.03] [49]. In addition, the clinical cost-effectiveness analysis of Xinmailong Injection in the treatment of HF showed that, compared with the conventional treatment group, the combination of Xinmailong and conventional treatment group had low cost, high efficiency, and better economic benefits.…”