Saffron (Crocus sativus L.) and health outcomes: a meta-research review of meta-analyses and an evidence mapping study

Lu, Cuncun; Ke, Lixin; Li, Jieyun; Zhao, Hanqing; Lu, Tingting; Mentis, Alexios‐Fotios A.; Wang, Youyou; Wang, Zhifei; Polissiou, Moschos G.; Tang, LiYao; Tang, Jing; Yang, Kehu

doi:10.1016/j.phymed.2021.153699

Cited by 32 publications

(35 citation statements)

References 41 publications

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“…Studies that met the following criteria were included: 1) type of studies: peer-reviewed pairwise or network MAs (without restriction on the study design of primary studies) published in English, and with the definition of MAs used in this methodological overview consistent with our previous publication ( Lu et al, 2021 ); 2) type of participants: patients with gastric cancer confirmed by histology and/or imaging examination, regardless of age, sex, tumor stage, educational background, socioeconomic status, nationality, and race/ethnicity; 3) type of interventions: ① CM combined with chemotherapy vs chemotherapy or other CMs alone, ② CM vs chemotherapy, ③ comparison of different CMs, without formulation, dosage, usage, and treatment duration restrictions; 4) type of clinical outcomes: any pooled clinical outcome related to efficacy or safety reported in the included MAs was considered appropriate.…”

Section: Methodsmentioning

confidence: 99%

“…The multicollinearity was not obvious when variance inflation factor (VIF) was less than 6 ( Li et al, 2019 ). The evidence mapping method was used to visualize the overall methodological quality for each of MA ( Chen et al, 2021 ; Lu et al, 2021 ). In an evidence map, each bubble represented a publication, with the size of the bubble proportional to the total number of patients included in each MA, the color showing the types of MA (i.e., pairwise or network MA), the X -axis indicating the overall confidence (i.e., “H,” “M,” “L,” “CL”) according to the AMSTAR-2 tool, and the Y -axis indicating the publication year of each MA.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, based on our previous study ( Lu et al, 2021 ), we designed a methodological overview to fill the aforementioned pending knowledge gaps. Specifically, this methodological research had two main objectives: 1) using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) ( Shea et al, 2017 ) tool to identify methodological weaknesses in published MAs that focused on CM as an adjunctive treatment for gastric cancer, doing so can contribute to improving the design, implementation and reporting of future relevant MAs; 2) comprehensively summarizing available evidence on the efficacy and safety of CMs combined with other treatments of gastric cancer, providing evidence support to aid clinician decision-making, and developing clinical practice guidelines, especially in settings where CMs are heavily practiced.…”

Section: Introductionmentioning

confidence: 99%

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Chinese Medicine as an Adjunctive Treatment for Gastric Cancer: Methodological Investigation of meta-Analyses and Evidence Map

et al. 2022

Front. Pharmacol.

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Background: Many meta-analyses (MAs) on Chinese medicine (CM) as an adjunctive treatment for gastric cancer have been published in recent years. However, the pooled evidence reported in MAs and their methodological quality remain unknown. Therefore, we designed a study to comprehensively evaluate and summarize the current evidence of CMs for gastric cancer in published MAs.Methods: A systematic search on MAs published in English from inception to 1st September 2021 was conducted in PubMed and Embase. The AMSTAR-2 tool was used to evaluate the methodological quality of the included MAs, and the results of the quality assessment were visualized using the evidence mapping method. Stata 17/SE was used for statistical analysis (Registration number: INPLASY202190005).Results: A total of 20 MAs (16 pairwise and 4 network MAs) were included from 118 records. These MAs were published in 14 journals from 2013 to 2021, with the number of patients and trials ranging from 688 to 6,857, and from 10 to 85, respectively. A large number of CMs (e.g., AiDi, FuFangKuShen, and HuaChanSu) in combination with chemotherapy for gastric cancer were identified among the included MAs. According to the pooled results reported in MAs, when compared to chemotherapy alone, CMs in combination with chemotherapy not only improve various outcomes on efficacy (e.g., objective response rate, quality of life) but also reduce various adverse reactions (e.g., leucopenia, nausea and vomiting). Only 2 MAs were low in terms of the overall methodological quality, while the other 18 MAs were all critically low. The methodology was required to be advanced significantly, mainly involving: study protocol and registration, explanation for the inclusion of study design, list of excluded studies with justifications, adequate details of included studies, reporting on funding sources of primary studies, and evaluation of the potential impact of risk of bias. In addition, MAs that received funds support (β = 2.68; 95%CI: 0.40 to 4.96; p = 0.024) or were published in journals with higher impact factor (β = 2.81; 95%CI: 0.69 to 4.92; p = 0.012) had a higher score on the overall methodological quality in the univariate analysis, but the results were not statistically significant according to the multivariate analysis.Conclusion: Combining CMs with chemotherapy can potentially improve clinical outcomes and reduce the relevant adverse effects in patients with gastric cancer. However, the methodological quality of relevant MAs requires significant improvement, and the current evidence needs to be validated through multinational trials that are well-designed and have a large sample size.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chinese Medicine as an Adjunctive Treatment for Gastric Cancer: Methodological Investigation of meta-Analyses and Evidence Map

et al. 2022

Front. Pharmacol.

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“…Today, 80% of the global saffron production is harvested from Iran, and this is why Iranian researchers are keen on investigating the plant's properties [57]. Nevertheless, according to an umbrella review [94], when studying the available literature, the need to conduct higher-quality trials outside of Iran becomes apparent, in order to reduce bias. All trials included in the present SWiM were conducted in Iran.…”

Section: Country Of Originmentioning

confidence: 99%

“…Moreover, the high clinical and methodological heterogeneity among the included trials did not allow for a meta-analysis to be performed. According to a recent umbrella systematic review [94], RCTs evaluating saffron interventions entail a variety of biases, and their methodology should be improved.…”

Section: Limitations Of the Present Qualitative Synthesismentioning

confidence: 99%

Effect of Crocus sativus (Saffron) Intake on Top of Standard Treatment, on Disease Outcomes and Comorbidities in Patients with Rheumatic Diseases: Synthesis without Meta-Analysis (SWiM) and Level of Adherence to the CONSORT Statement for Randomized Controlled Trials Delivering Herbal Medicine Interventions

et al. 2021

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Rheumatic diseases (RDs) are often complicated by chronic symptoms and frequent side-effects associated with their treatment. Saffron, a spice derived from the Crocus sativus L. flower, is a popular complementary and alternative medicine among patients with RDs. The present systematic review aimed to summarize the available evidence regarding the efficacy of supplementation with saffron on disease outcomes and comorbidities in patients with RD diagnoses. PubMed, CENTRAL, clinicaltrials.gov and the grey literature were searched until October 2021, and relevant randomized controlled trials (RCTs) were screened for eligibility using Rayyan. Risk of bias was assessed using the Cochrane’s Risk of Bias-2.0 (RoB) tool. A synthesis without meta-analysis (SWiM) was performed by vote counting and an effect direction plot was created. Out of 125 reports, seven fulfilled the eligibility criteria belonging to five RCTs and were included in the SWiM. The RCTs involved patients with rheumatoid arthritis, osteoarthritis and fibromyalgia, and evaluated outcomes related to pain, disease activity, depression, immune response, inflammation, oxidative stress, health, fatigue and functional ability. The majority of trials demonstrated some concerns regarding overall bias. Moreover, the majority of trialists failed to adhere to the formula elaborations suggested by the CONSORT statement for RCTs incorporating herbal medicine interventions. Standardization of herbal medicine confirms its identity, purity and quality; however, the majority of trials failed to adhere to these guidelines. Due to the great heterogeneity and the lack of important information regarding the standardization and content of herbal interventions, it appears that the evidence is not enough to secure a direction of effect for any of the examined outcomes.

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Saffron (Crocus sativus) and its constituents for pain management: A review of current evidence

Pourbagher‐Shahri

Forouzanfar

2023

Phytotherapy Research

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Pain can become a chronic and deliberating experience with a significant burden. In preclinical and clinical studies, Saffron (Crocus sativus L.) has shown analgesic activities. Considering the unsatisfactory results of current therapeutic management for chronic pain conditions, we aimed to review saffron's analgesic activity and underlying mechanisms. Saffron showed antinociceptive activities in formalin‐, carrageenan‐, and capsaicin‐induced experimental pain models. Saffron analgesic activities affected several targets, including ion channels of nociceptors; the adrenergic system and central histaminic system; inhibition of inflammatory pathways, apoptotic pathways, and oxidative stress; regulation of NO pathway, and the endocannabinoid system. Clinical studies showed analgesia of Saffron in rheumatoid arthritis, after‐pain following childbirth, dysmenorrhea, and fibromyalgia. Our literature review showed that saffron can be beneficial as an adjunct therapy to commonly used analgesics in practice, particularly in chronic pain conditions.

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Saffron (Crocus sativus L.) and health outcomes: a meta-research review of meta-analyses and an evidence mapping study

Cited by 32 publications

References 41 publications

Chinese Medicine as an Adjunctive Treatment for Gastric Cancer: Methodological Investigation of meta-Analyses and Evidence Map

Chinese Medicine as an Adjunctive Treatment for Gastric Cancer: Methodological Investigation of meta-Analyses and Evidence Map

Saffron (Crocus sativus) and its constituents for pain management: A review of current evidence

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