The efficacy and safety of compound glycyrrhizin combined with desloratadine in the treatment of chronic urticaria: protocol for a systematic review of randomized controlled trials

Abstract

Background: Chronic urticaria (CU) is a common skin disease characterized by a short-term (<24 hours) spontaneous skin rash (urticaria) with or without angioedema that lasts longer than 6 weeks. CU is not life-threatening but has been shown to have a significant impact on the physical and mental health of patients. Because of chronic itching or physical discomfort in patients with CU, symptoms such as the repeated occurrence of red, swollen, itchy, anxiety, insomnia, and psychological stress are prone to occur. Whereas, there is no related systematic review and meta-analysis. Thus, this systematic review protocol aims to describe a systematic review and meta-analysis to testify the efficacy and safety of compound glycyrrhizin (CG) combined with desloratadine in the treatment of CU.Methods: Our systematic review will search all randomized controlled trials (RCTs) for CG combined with desloratadine in the treatment of CU, electronically and manually, regardless of publication status and language, until January 14, 2020. Databases include PubMed, EMBASE, Web of Science, Cochrane Controlled Trials Register (CENTRAL), China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Chinese Science Journal Database (VIP Database) and Wanfang database. Other sources, including reference lists of identified publications and meeting minutes, will also be searched. Manually search for grey literature, including unpublished conference articles. The main outcomes contain the total effective rate, the urticaria activity score (UAS), Itching score, the chronic urticaria quality of life questionnaire (CU-Q2oL), or other validated symptom scores and the effective rate and adverse events from baseline to the end of studies. This study will provide a comprehensive review of the available evidence for the treatment of CU with this therapy. We will assess the risk of bias with the Cochrane Risk of Bias Tool, narratively synthesize the extracted data and conduct a meta-analysis of studies with similar characteristics. Two independent raters will screen articles and assess the risk of bias.Discussion: This study will provide a high-quality synthesis of the effects of compound glycyrrhizin (CG) combined with desloratadine in the treatment of CU. We hope that this review will give more convincing proof to assist clinicians during the decision-making process when dealing with CU.Systematic review registration: PROSPERO CRD42020165478

Efficiency and safety of desloratadine in combination with compound glycyrrhizin in the treatment of chronic urticaria: a meta-analysis and systematic review of randomised controlled trials

“…Although long-term use of glycyrrhizin can cause electrolyte metabolism abnormalities, glycyrrhizinate containing glycine can be combined with L-cysteine hydrochloride to inhibit or reduce electrolyte metabolism disorders (Grob et al 2005). In addition, compound glycyrrhizin can improve the level of CD4þ T cells, reduce the level of CD8þ T cells, inhibit the release of arachidonic acid, and reduce leukotrienes (Wang 2016). Desloratadine in combination with compound glycyrrhizin can produce effects on different aspects of this disease, forming synergetic and complementary advantages in immune regulation and antiallergy, prolong the time of drug action, reduce the sensitivity of the body, enhance the clinical efficacy and reduce the recurrence of the disease.…”

Efficacy and safety of compound glycyrrhizin in combination with conventional therapy in treatment of vitiligo: A systematic review and meta-analysis of randomized controlled trials

“…Besides, both showed a low rate of AEs. In addition to common AEs of conventional therapy such as pruritus, erythema or papule, pseudoaldosteronism should be a specific adverse event of CG, 2 studies found CG might increase blood pressure, [44,57] 9 studies cause edema including lower feet edema, eyelids edema or facial edema, [29,3 1,34,36,38,40,44,48,57] and 2 studies found hypokalemia. [47,52] Patients with hypertension or cardiovascular disease should be cautious in receiving CG.…”

“…All studies were randomized controlled, but only eleven reported generation of random sequence and were evaluated as low risk. [29][30][31]36,41,42,44,45,57,60,61] All studies were classified as low-risk about selective reporting, incomplete outcome, other bias. All were judged as high risk in terms of performance bias since the lack of blinding of participants and personnel.…”

“…Pooled data from 6 trials [41][42][43][44][45][46] showed that a combination of CG and immunosuppressant had a better therapeutic effect than immunosuppressant alone (RR = 1.76, 95% CI: 1.49-2.08, P < .001), with no significant heterogeneity was noticed (I 2 = 41%), as shown in Figure 4.…”

Effects of BCG‐PSN on the Levels of Inflammatory Factors and Th1/Th2 Differentiation in Chronic Spontaneous Urticaria: Meta‐Analysis and Systematic Review

“…Ten studies [19,21,24,27,33,34,[36][37][38]41] reported methods of randomizing participants by using random number tables, which were considered low risk of bias; 13 trials mentioned randomization but did not explain the randomization method in detailed [17,18,20,23,25,26,28,30,31,35,39,40,42]; these were considered unclear risk of bias; and 3 trials [29,32,43] were grouped by treatment approach and one study [22] by visit sequence; the four studies were identifed as high-risk bias. None of the studies mentioned blindness and allocation hiding, which were considered unclear risk of bias.…”