Comparative Evidence for Intrahepatic Cholestasis of Pregnancy Treatment With Traditional Chinese Medicine Therapy: A Network Meta-Analysis

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) seriously threatens the health of pregnant women and newborns. A various number of Chinese prescriptions and patent medicines combined with ursodeoxycholic acid (UDCA) are used for treating ICP in China. However, there are still many doubts in choosing the suitable therapeutic drugs for the treatment of ICP in clinical practice.Methods: Several electronic databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang, and VIP, were comprehensively searched from the database inception to February 22, 2021. Randomized controlled trials (RCTs) reporting the use of UDCA only, Chinese prescriptions plus UDCA, and patent medicine plus UDCA for the treatment of ICP were collected according to their inclusion and exclusion criteria. Cochrane Reviewers’ Handbook version 5.2 was applied for the risk assessment of the included trials. STATA 16.0 software was used for network meta-analysis (NMA). The pruritus score and the serum levels of total bile acid (TBA), alanine aminotransferase (ALT), and aspartate transaminase (AST) in ICP patients served as the primary outcomes. Moreover, this study had been registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/#joinuppage), and the registration number is CRD42020188831.Results: Thirty-eight RCTs comprising 3,841 patients meeting the inclusion criteria were included in the network meta-analysis. The NMA results showed that compared with UDCA used alone, Yinchenhao decoction (seven different Chinese prescriptions or patent medicines) plus UDCA dramatically alleviated the primary outcomes of ICP, including the pruritus score, as well as the serum levels of TBA, ALT, and AST. The NMA results showed that the optimal drug ratio for the treatment of ICP was different from the dosage ratio of traditional Yinchenhao decoction. Significantly, the intervention plan f (IP-f) group [the similar prescription of Yinchenhao decoction 2 (Artemisia capillaris Thunb >15 g, Gardenia >9 g, and Rhubarb <5 g) + UDCA] was the best therapeutics among the eight therapies.Conclusion: Overall, the combined use of Chinese prescriptions or patent medicine with UDCA was generally better than UDCA used alone. The dose of IP-f might be a beneficial therapeutic method for the clinical medication of ICP.Clinical Trail Registration:https://www.crd.york.ac.uk/, identifier CRD42020188831.

Retracted: Maternal traditional Chinese medicine exposure and risk of congenital malformations: a multicenter prospective cohort study

“…2,3 Additionally, TCM is also used in the treatment of gestational diseases, such as influenza/cold, 4 gestational diabetes mellitus, 5 hypertension 6 and intrahepatic cholestasis. 7 These findings, together with the claim that TCM is natural and safe, 8 have been greatly promoted by pregnant women in mainland China (10.1%), 4 Taiwan (20.2%-35%) 9 and Hong Kong (55.8%). 10 Thalidomide and diethylstilboestrol result in severe birth defects, therefore health professionals have been concerned about the safety of other medicines during pregnancy.…”

“…Previous studies have identified that TCM showed efficiency or additional utility in the preparation and maintenance of pregnancy 2,3 . Additionally, TCM is also used in the treatment of gestational diseases, such as influenza/cold, 4 gestational diabetes mellitus, 5 hypertension 6 and intrahepatic cholestasis 7 . These findings, together with the claim that TCM is natural and safe, 8 have been greatly promoted by pregnant women in mainland China (10.1%), 4 Taiwan (20.2%–35%) 9 and Hong Kong (55.8%) 10 …”

Hepatoprotective agents in the management of intrahepatic cholestasis of pregnancy: current knowledge and prospects

“…Advantage from this is a more individualized treatment plan. In China, TCM are widely applied with combination of UDCA for the treatment of ICP ( Jiang et al, 2021 ; Wei et al, 2022 ). The treatment for ICP mainly focused hepatoprotection and promoting circulation of bile.…”

“…A network meta-analysis by included 38 RCTs exploring the effect of Yinchenhao in ICP pregnancies. Their results demonstrated that when compared with UDCA used alone, Yinchenhao decoction plus UDCA dramatically reduced the serum levels of bile acid, ALT, and AST ( Jiang et al, 2021 ). Recent clinical trials of Yinchenhao in ICP pregnancies are summarized in Supplementary Tables S1, S2 ( Wang et al, 2019 ; Chen et al, 2020 ; Xu et al, 2021 ; Zhu, 2021 ) ( Supplementary Tables S1, S2 ).…”

Clinical Effect of <italic>Injinho-tang</italic> on Hyperbilirubinemia in Hepatobiliary Disorders: A Systematic Review

“…기존의 고찰 문헌들에도 이러한 연구들이 포함 되어 있었다29,30,[34][35][36] . 따라서, 기존 연구들에서 제시 된 결과들을 다시 확인하여 정리하고, 아울러 인진 호탕이 투여될 수 있는 간담도계 질환들 전반에 대하여 보편적으로 기대할 수 있는 효과크기를 산 정해보고자 하였다.…”