Comparative efficacy of seven Chinese patent medicines for early diabetic kidney disease: A Bayesian network meta-analysis

Objectives: To evaluate and compare the efficacy, safety, and cost of nine Chinese patent medicines (CPMs) combined with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) in treating early diabetic kidney disease (DKD).Design: Systematic review and network meta-analysis.Data sources: PubMed, Embase, Cochrane Library, Web of Science, clinicaltrials.gov, SinoMed, Chinese Biomedicine, China National Knowledge Infrastructure, WanFang, and Chongqing VIP Information databases were comprehensively searched from the beginning to February 2022.Review Methods: Randomized controlled trials (RCTs) including Bailing capsule (BLC); Jinshuibao capsule (JSB); Huangkui capsule (HKC); Compound Xueshuantong capsule (CXC); uremic clearance granule (UCG); Shenyan Kangfu tablet (SYKFT); tripterygium glycosides (TG); Keluoxin capsule (KLX), and Shenshuaining tablet (SSNT) combined with ACEI/ARB for patients with early DKD were reviewed.Data Synthesis: Two reviewers independently screened articles, extracted data, and assessed the risk of bias. Risk ratios (RRs) and mean difference (MD) were reckoned to assess dichotomous variable quantities and continuous variable quantities, respectively. Using the surface under the cumulative ranking curve (SUCRA), we then ranked each therapeutic regime.Results: Ultimately, 160 RCTs involving 13,365 patients and nine CPMs were included. UCG showed significantly higher probabilities on urinary albumin excretion rate (UAER) when compared with ACEI/ARB group, with MD of −47 (95%CI) (−57, −37) and SUCRA 98.0%. The CXC group achieved a remarkable improvement in overall response rate (ORR) compared with ACEI/ARB (RR, 1.3, 95%CI (1.2, 1.5)) with SUCRA 91.9%. SSNT could be significantly superior to ACEI/ARB group in terms of serum creatinine (Scr) (−19 (−26, −12), SUCRA 99.3%) and adverse effects (AEs) (0.46 (0.17, 1.1), SUCRA 82.9%). BLC showed the greatest effectiveness on 24 h urinary total protein (24 h UTP) (−170 (−260, −83), SUCRA 78.5%) and triglyceride (Trig) (−0.89 (−1.2, −0.53), SUCRA 97.0%). From the cost-effectiveness analysis of CPMs in China, the cost of TG, SYKFT and CXC was 108, 600, and 648 RMB, respectively, per 3 months and were ranked in the top three.Conclusion: UCG and CXC might be the optimum selection for improving UAER and ORR, and SSNT could be significantly superior to ACEI/ARB group in terms of Scr and AEs. BLC shows the best curative effect on 24 h UTP and Trig. TG shows the highest cost-effectiveness among the nine CPMs.

Section: Discussioncontrasting

confidence: 88%

“…At the same time, more RCTs with high-quality, large-sample, and multi-center about SSNT and SYKFT are needed to verify our findings in the future. As for the SUCRA, UCG combined with ACEI/ARB was ranked first among ten interventions with SUCRA 98.0%, which was consistent with the study conducted by Zhao et al (2022) .…”

Section: Discussionsupporting

confidence: 86%

Clinical efficacy, safety, and cost of nine Chinese patent medicines combined with ACEI/ARB in the treatment of early diabetic kidney disease: A network meta-analysis

Liu

Zhang

2022

“…Previous study showed that Niaoduqing had better effect on controlling proteinuria in patients with early stage DN (Zhao et al, 2022). Since podocyte damage is the major cause of proteinuria, Niaoduqing might be able to protect podocyte during early stage DN.…”

Section: Niaoduqing Ingredients Protect Against Hg-induced Mpc5 Cell ...mentioning

confidence: 97%

“…Compared with using ACEI/ARB alone, the better renal function is observed in patients received combination therapy with Niaoduqing (Li et al, 2016;Wei and Ruan, 2018). What's more, a recent network meta-analysis reported that Niaoduqing has a better effect on controlling proteinuria in patients with early stage DN, compared with other six kinds of TCM (Zhao et al, 2022). Although some studies have proved the positive role of Niaoduqing in the treatment of diabetes nephropathy and proteinuria, the underline mechanisms of Niaoduqing for early stage DN are still unclear and need to be further explored.…”

Section: Introductionmentioning

confidence: 99%

Niaoduqing alleviates podocyte injury in high glucose model via regulating multiple targets and AGE/RAGE pathway: Network pharmacology and experimental validation

Fang

Zhang²,

Jia³

et al. 2023

Purpose: The aim of present study was to explore the pharmacological mechanisms of Niaoduqing granules on the treatment of podocyte injury in diabetic nephropathy (DN) via network pharmacology and experimental validation.Methods: Active ingredients and related targets of Niaoduqing, as well as related genes of podocyte injury, proteinuria and DN, were obtained from public databases. Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and protein-protein interaction (PPI) network analysis were performed to investigate the potential mechanisms. High glucose (HG) -induced MPC5 cell injury model was treated with the major core active ingredients of Niaoduqing and used to validate the predicted targets and signaling pathways.Results: Totally, 16 potential therapeutic targets were identified by intersecting the targets of Niaoduqing and disease, in which 7 of them were considered as the core targets via PPI network analysis. KEGG enrichment analysis showed that AGE-RAGE signaling pathway was identified as the most crucial signaling pathway. The results of in vitro experiments revealed that the treatment of Niaoduqing active ingredients significantly protected MPC5 cells from HG-induced apoptosis. Moreover, Niaoduqing could significantly attenuate the HG-induced activation of AGE-RAGE signaling pathway, whereas inhibited the over-expression of VEGF-A, ICAM-1, PTGS-2 and ACE in HG-induced MPC5 cells.Conclusion: Niaoduqing might protect against podocyte injury in DN through regulating the activity of AGE/RAGE pathway and expression of multiple genes. Further clinical and animal experimental studies are necessary to confirm present findings.

“…To the best of our knowledge, this study is the first to compare the differences in the efficacy of TCMIs in the treatment of DKD through a network meta-analysis. Most of the previous studies (Zhang et al, 2022;Zhao et al, 2022), only conducted systematic reviews and network meta-analyses on TCM decoction. Those studies could not have stable quality control due to the diversity of ingredients and dose variability.…”

Section: Relationships and Comparisons With Other Studiesmentioning

confidence: 99%

Efficacy of traditional Chinese medicine injection for diabetic kidney disease: A network meta analysis and systematic review

Long

Feng²,

Liu³

et al. 2023

Background: Diabetic kidney disease (DKD) is an important public health problem worldwide that increases the mortality of patients and incurs high medical costs. Traditional Chinese Medicine injections (TCMIs) are widely used in clinical practice. However, their efficacy is unknown owing to a lack of definitive evidence. This study conducted a network meta-analysis (NMA) to evaluate the efficacy and safety of traditional Chinese medicine injections in the treatment of DKD to provide a reference for clinical treatment.Methods: Total 7 databases had been searched, which included PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese scientific journal database (VIP), WanFang, and SinoMed. Only randomised controlled trials (RCT) had been included for analysis. The retrieval time limit was from the establishment of the database until 20 July 2022. Cochrane Risk of Bias 2.0 tool was used to evaluate the quality of the studies. Network meta-analyses, and Trial Sequential Analyses (TSA) were used to analysis the effectiveness of the included RCTs for DKD. The Stata 15.1 and R 4.0.4 were used to perform the network meta-analysis. Sensitivity analysis was used to assess the robustness of the findings. The effect of the intervention evidence are summarized on the basis of the minimum background framework.Results: NMA showed that the total effective rate of SMI, DCI, DHI, HQI, and SKI combined with alprostadil injection (PGE1) was better than PGE1 single used. Based on the surface under the cumulative ranking curve values, PGE1+DHI was the most effective for urinary albumin excretion rate and 24 h urinary albumin, PGE1+HQI was the most effective for the total response rate and β2-MG, and PGE1+SKI was the most effective for serum creatinine and blood urea nitrogen. Cluster analysis found that PGE1+HQI and PGE1+SKI could be the best treatments in terms of primary outcome measures. PGE1+SKI was found to be most effective on glomerular filtration function. PGE1+DHI was most effective for urinary protein-related indices.Conclusion: The efficacy of TCMI combined with PGE1 was higher than PGE1 single used. PGE1+HQI and PGE1+SKI were the most effective treatments. The safety of TCMI treatment should be investigated further. This study needs to be validated using large-sample, double-blind, multicentre RCTs.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=348333], identifier [CRD42022348333].