Efficacy and Safety of Traditional Chinese Medicine Injections for Heart Failure With Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

Background: Heart failure as an important issue in global public health, has brought a heavy economic burden. Traditional Chinese medicine injections (TCMIs) have significant effects on heart failure with reduced ejection fraction (HFrEF). However, it is difficult for clinicians to identify the diff...

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Autores principales:	Shanshan Lin, Qingyang Shi, Zhao Ge, Yangxi Liu, Yawen Cao, Ying Yang, Zhiqiang Zhao, Yingfei Bi, Yazhu Hou, Shuai Wang, Xianliang Wang, Jingyuan Mao
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	traditional chinese medicine traditional chinese medicine injection heart failure randomized controlled trial network meta-analysis bayesian model Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/3895c6997dd94ea085abb5b1c8a047f8
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spelling	oai:doaj.org-article:3895c6997dd94ea085abb5b1c8a047f82021-12-01T18:54:15ZEfficacy and Safety of Traditional Chinese Medicine Injections for Heart Failure With Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials1663-981210.3389/fphar.2021.659707https://doaj.org/article/3895c6997dd94ea085abb5b1c8a047f82021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphar.2021.659707/fullhttps://doaj.org/toc/1663-9812Background: Heart failure as an important issue in global public health, has brought a heavy economic burden. Traditional Chinese medicine injections (TCMIs) have significant effects on heart failure with reduced ejection fraction (HFrEF). However, it is difficult for clinicians to identify the differences in clinical efficacy and safety of various TCMIs. The purpose of this study is to compare the efficacy and safety of various TCMIs for treating HFrEF by conducting a Bayesian network meta-analysis (NMA) and to further provide references for clinical decision-making.Methods: The clinical randomized controlled trials of TCMIs for treating HFrEF were searched in seven database from inception to August 3rd, 2021. The Cochrane collaboration’s tool was used to assess the risk of bias. NMA was performed in a Bayesian hierarchical framework. The surface under the cumulative ranking curve (SUCRA), the multi-dimensional efficacy analysis, the comparison-adjusted funnel plot, and the node-splitting analysis were conducted using R software.Results: A total of 107 eligible RCTs involving 9,073 HFrEF patients and 6 TCMIs were included. TCMIs include Huangqi injection (HQ) also called Astragalus injection, Shenfu injection (SF), Shengmai injection (SGM), Shenmai injection (SM), Xinmailong injection (XML), and Yiqifumai lyophilized injection (YQFM). The results of NMA and SUCRA showed that with conventional treatment (CT) as a common control, in terms of clinical efficacy, CT + XML was most effective in New York Heart Association cardiac functional classification efficiency, brain natriuretic peptide, and N-terminal pro-brain natriuretic peptide; the CT + SM was most effective in 6-min walking test, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac output; the CT + YQFM was most effective in left ventricular ejection fraction; the CT + HQ was most effective in stroke volume; the CT + SF was most effective in Minnesota Living with Heart Failure Questionnaire. In terms of safety, there was no significant difference between CT + TCMIs and CT.Conclusion: This Bayesian network meta-analysis results show that the combination of qualified TCMIs and CT is more effective for HFrEF patients than CT alone, and CT + XML and CT + SM may be one of the potential optimal treatments. Also, the safety of these TCMIs needs to be further observed. However, due to some limitations, the conclusions need to be verified by more large-sample, double-blind, multi-center RCTs.Shanshan LinShanshan LinQingyang ShiZhao GeZhao GeYangxi LiuYangxi LiuYawen CaoYawen CaoYing YangZhiqiang ZhaoYingfei BiYazhu HouShuai WangXianliang WangJingyuan MaoFrontiers Media S.A.articletraditional chinese medicinetraditional chinese medicine injectionheart failurerandomized controlled trialnetwork meta-analysisbayesian modelTherapeutics. PharmacologyRM1-950ENFrontiers in Pharmacology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	traditional chinese medicine traditional chinese medicine injection heart failure randomized controlled trial network meta-analysis bayesian model Therapeutics. Pharmacology RM1-950
spellingShingle	traditional chinese medicine traditional chinese medicine injection heart failure randomized controlled trial network meta-analysis bayesian model Therapeutics. Pharmacology RM1-950 Shanshan Lin Shanshan Lin Qingyang Shi Zhao Ge Zhao Ge Yangxi Liu Yangxi Liu Yawen Cao Yawen Cao Ying Yang Zhiqiang Zhao Yingfei Bi Yazhu Hou Shuai Wang Xianliang Wang Jingyuan Mao Efficacy and Safety of Traditional Chinese Medicine Injections for Heart Failure With Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
description	Background: Heart failure as an important issue in global public health, has brought a heavy economic burden. Traditional Chinese medicine injections (TCMIs) have significant effects on heart failure with reduced ejection fraction (HFrEF). However, it is difficult for clinicians to identify the differences in clinical efficacy and safety of various TCMIs. The purpose of this study is to compare the efficacy and safety of various TCMIs for treating HFrEF by conducting a Bayesian network meta-analysis (NMA) and to further provide references for clinical decision-making.Methods: The clinical randomized controlled trials of TCMIs for treating HFrEF were searched in seven database from inception to August 3rd, 2021. The Cochrane collaboration’s tool was used to assess the risk of bias. NMA was performed in a Bayesian hierarchical framework. The surface under the cumulative ranking curve (SUCRA), the multi-dimensional efficacy analysis, the comparison-adjusted funnel plot, and the node-splitting analysis were conducted using R software.Results: A total of 107 eligible RCTs involving 9,073 HFrEF patients and 6 TCMIs were included. TCMIs include Huangqi injection (HQ) also called Astragalus injection, Shenfu injection (SF), Shengmai injection (SGM), Shenmai injection (SM), Xinmailong injection (XML), and Yiqifumai lyophilized injection (YQFM). The results of NMA and SUCRA showed that with conventional treatment (CT) as a common control, in terms of clinical efficacy, CT + XML was most effective in New York Heart Association cardiac functional classification efficiency, brain natriuretic peptide, and N-terminal pro-brain natriuretic peptide; the CT + SM was most effective in 6-min walking test, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac output; the CT + YQFM was most effective in left ventricular ejection fraction; the CT + HQ was most effective in stroke volume; the CT + SF was most effective in Minnesota Living with Heart Failure Questionnaire. In terms of safety, there was no significant difference between CT + TCMIs and CT.Conclusion: This Bayesian network meta-analysis results show that the combination of qualified TCMIs and CT is more effective for HFrEF patients than CT alone, and CT + XML and CT + SM may be one of the potential optimal treatments. Also, the safety of these TCMIs needs to be further observed. However, due to some limitations, the conclusions need to be verified by more large-sample, double-blind, multi-center RCTs.
format	article
author	Shanshan Lin Shanshan Lin Qingyang Shi Zhao Ge Zhao Ge Yangxi Liu Yangxi Liu Yawen Cao Yawen Cao Ying Yang Zhiqiang Zhao Yingfei Bi Yazhu Hou Shuai Wang Xianliang Wang Jingyuan Mao
author_facet	Shanshan Lin Shanshan Lin Qingyang Shi Zhao Ge Zhao Ge Yangxi Liu Yangxi Liu Yawen Cao Yawen Cao Ying Yang Zhiqiang Zhao Yingfei Bi Yazhu Hou Shuai Wang Xianliang Wang Jingyuan Mao
author_sort	Shanshan Lin
title	Efficacy and Safety of Traditional Chinese Medicine Injections for Heart Failure With Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_short	Efficacy and Safety of Traditional Chinese Medicine Injections for Heart Failure With Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_full	Efficacy and Safety of Traditional Chinese Medicine Injections for Heart Failure With Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_fullStr	Efficacy and Safety of Traditional Chinese Medicine Injections for Heart Failure With Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed	Efficacy and Safety of Traditional Chinese Medicine Injections for Heart Failure With Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_sort	efficacy and safety of traditional chinese medicine injections for heart failure with reduced ejection fraction: a bayesian network meta-analysis of randomized controlled trials
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/3895c6997dd94ea085abb5b1c8a047f8
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Efficacy and Safety of Traditional Chinese Medicine Injections for Heart Failure With Reduced Ejection Fraction: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

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