DataSheet1_Herbal Medicine Intervention for the Treatment of COVID-19: A Living Systematic Review and Cumulative Meta-Analysis.docx

Background: Integrative herbal medicine has been reported to have beneficial effects in the treatment of coronavirus disease 2019 (COVID-19).
Aim: To compile up-to-date evidence of the benefits and risks of herbal medicine for the treatment of COVID-19 symptoms.
Methods: Eleven databases, including PubMed, Cochrane Register of Controlled Trials (CENTRAL), Embase, Allied and Complementary Medicine Database (AMED), Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Database, and Chinese Science and Technique Journals Database (VIP), Research Information Service System (RISS), Korean Medical database (KMBase), Korean Association of Medical Journal database (KoreaMed), and OASIS database, were searched from 15 June, 2020, until 28 March 2022. Randomized controlled trials (RCTs), published in any language, reporting the efficacy and safety outcomes of herbal medicine in patients of all ages with a PCR-confirmed diagnosis of COVID-19 were included in this analysis. Data extraction and quality assessments were performed independently.
Results: Random-effects meta-analyses showed evidence of favorable effects of treatment with herbal medicine when added to standard treatment, versus standard treatment alone, on the total effective rate (p = 0.0001), time to remission from fever (p < 0.00001), rate of remission from coughing (p < 0.0001), fatigue (p = 0.02), sputum production (p = 0.004), improvement of manifestations observed on chest computed tomography scans (p < 0.00001), incidence of progression to severe COVID-19 (p = 0.003), all-cause mortality (p = 0.003), time to a negative COVID-19 coronavirus test (p < 0.0001), and duration of hospital stay (p = 0.0003). There was no evidence of a difference between herbal medicine added to standard treatment, versus standard treatment alone, on the rate of remission from symptoms such as a fever, sore throat, nasal congestion and discharge, diarrhea, dry throat, chills, and the rate of conversion to a negative COVID-19 coronavirus test. Meta-analysis showed no evidence of a significant difference in adverse events between the two groups. There was an unclear risk of bias across the RCTs included in this analysis, indicating that most studies had methodological limitations.
Conclusion: Current evidence suggests that herbal medicine added to standard treatment has potential benefits in the treatment of COVID-19 symptoms but the certainty of evidence was low.

背景：已有研究表明，整合式草药疗法在2019冠状病毒病（COVID-19）的治疗中可发挥有益作用。
目的：系统梳理草药疗法用于治疗COVID-19相关症状的获益与风险的最新研究证据。
方法：本研究检索了11个数据库，包括PubMed、Cochrane对照试验中心注册库（Cochrane Register of Controlled Trials, CENTRAL）、Embase、辅助与替代医学数据库（Allied and Complementary Medicine Database, AMED）、中国国家知识基础设施数据库（Chinese National Knowledge Infrastructure Database, CNKI）、万方数据库、中国科技期刊数据库（Chinese Science and Technique Journals Database, VIP）、研究信息服务系统（Research Information Service System, RISS）、韩国医学数据库（Korean Medical database, KMBase）、韩国医学期刊协会数据库（Korean Association of Medical Journal database, KoreaMed）以及OASIS数据库，检索时限为2020年6月15日至2022年3月28日。本分析纳入所有语言发表的、针对经聚合酶链反应（polymerase chain reaction, PCR）确诊的各年龄段COVID-19患者、报告草药疗法疗效与安全性结局的随机对照试验（randomized controlled trial, RCT）。数据提取与质量评估工作均独立完成。
结果：随机效应模型荟萃分析结果显示，相较于单纯标准治疗，在标准治疗基础上联用草药疗法可显著改善多项结局指标：总有效率（p=0.0001）、发热缓解时间（p<0.00001）、咳嗽缓解率（p<0.0001）、疲劳症状改善（p=0.02）、痰液生成改善（p=0.004）、胸部计算机断层扫描（CT）影像学表现改善（p<0.00001）、进展为重型COVID-19的发生率（p=0.003）、全因死亡率（p=0.003）、新冠病毒核酸转阴时间（p<0.0001）以及住院时长（p=0.0003）。而在发热、咽痛、鼻塞流涕、腹泻、咽干、畏寒等症状的缓解率，以及新冠病毒核酸转阴率方面，联用草药疗法与单纯标准治疗组间未观察到显著统计学差异。荟萃分析结果显示，两组不良事件发生率无显著差异。本研究纳入的随机对照试验存在偏倚风险不确定性，提示多数研究存在方法学局限性。
结论：现有证据表明，在标准治疗基础上联用草药疗法对改善COVID-19相关症状具有潜在获益，但证据整体质量偏低。