Effect and safety of Chinese herbal medicine granules in patients with severe coronavirus disease 2019 in Wuhan, China: a retrospective, single-center study with propensity score matching

Abstract

Background : Chinese herbal medicine (CHM) has been used for severe illness caused by coronavirus disease 2019 (COVID-19), but its treatment effects and safety are unclear. Purpose : This study reviews the effect and safety of CHM granules in the treatment of patients with severe COVID-19. Methods : We conducted a single-center, retrospective study on patients with severe COVID-19 in a designated hospital in Wuhan from January 15, 2020 to March 30, 2020. The propensity score matching (PSM) was used to assess the effect and safety of the treatment using CHM granules. The ratio of patients who received treatment with CHM granules combined with usual care and those who received usual care alone was 1:1. The primary outcome was the time to clinical improvement within 28 days, defined as the time taken for the patients’ health to show improvement by decline of two categories (from the baseline) on a modified six-category ordinal scale, or to be discharged from the hospital before Day 28. Results : Using PSM, 43 patients (45% male) aged 65.6 (57–70) years from each group were exactly matched. No significant difference was observed in clinical improvement of patients treated with CHM granules compared with those who received usual ( P = 0.851). However, the use of CHM granules reduced the 28-day mortality ( P = 0.049) and shortened the duration of fever (4 days vs. 7 days, P = 0.002). The differences in the duration of cough and dyspnea and the difference in lung lesion ratio on computerized tomography scans were not significant. Commonly, patients in the CHM group had an increased D -dimer level ( P = 0.036). Conclusion : For patients with severe COVID-19, CHM granules, combined with usual care, showed no improvement beyond usual care alone. However, the use of CHM granules reduced the 28-day mortality rate and the time to fever alleviation. Nevertheless, CHM granules may be associated with high risk of fibrinolysis.

The effect of Chinese herbal medicine on digestive system and liver functions should not be neglected in COVID‐19: An updated systematic review and meta‐analysis

“…In total, we analyzed 48 studies 3–7,20–60 recruiting 4,704 patients with COVID‐19. Of these, 29 20,22–29,31,34–36,39,40,49–62 were observational studies with a control group, and 19 3–7,30,32,33,37,38,41–48,63 were RCTs included in the final analysis. Of these participants, 2,696 had been assigned to receive CHM as an adjuvant medicine, and 2,008 receive standard pharmacotherapy.…”

“…The other 13 studies 5–7,32,33,37,38,41–46 did not mention the blinding of patients and personnel. Table 3 showed the NOS details for 29 observational studies 20,22–29,31,34–36,39,40,49–62 . Eight observational studies 20,22,24,26,34,49,50,57 were judged to be of moderate methodologic quality, subject to the unsatisfying risk of bias mostly owing to the lack of adequacy of follow up and completing accounting for observational studies.…”

“…The aggravation of COVID‐19 among users and non‐users of CHM for COVID‐19 was assessed by 28 studies including 12 RCTs 4–6,30,33,38,41–44,48,63 and 16 controlled observational studies 22,25,26,28,29,31,35,36,39,50,52,58–62 . Of the total 3,415 COVID‐19 patients included, 2,011 received CHM along with standard pharmacotherapy and 1,404 received only standard pharmacotherapy.…”

Research progress of traditional Chinese medicine against COVID-19

“…Yuanyuan Wang et, al. summarized a single-center, retrospective study on patients with severe COVID-19 and found that the use of TCM granules reduced the 28-day mortality rate and the time to fever alleviation [ 130 ]. Extensive data have shown to support the therapeutic effects of TCM treatment, however, there are no large-scale clinical studies in China using TCM alone, most of which are in combination with other medical approaches, including antiviral drugs, nutritional support, antimicrobial agents and symptomatic support systems.…”

Severe Type of COVID-19: Pathogenesis, Warning Indicators and Treatment

“…(115) CM combined with conventional treatment has a protective effect on patients with severe COVID-19, and can reduce fever time and mortality. (116) A meta-analysis demonstrated that CM can effectively reduce severe cases, improve lung imaging manifestations, and shorten the length of hospital stay. (1) Qingfei Paidu Decoction (清肺排毒汤, QFPD), a prescription optimized from Maxing Shigan Decoction (麻 杏石甘汤, MXSG), Shegan Mahuang Decoction (射干麻黄 汤), Xiaochaihu Decoction (小柴胡汤), and Wuling Powder (五苓散), has been listed in the 6th edition of the protocol as a recommended prescription.…”