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Gong X, Liu WX, Tang XP, Wang J, Liu J, Huang QC, Liu W, Fang YF, He DY, Liu Y, Gao ML, Wu QJ, Chen S, Li ZB, Wang Y, Xie YM, Zhang JL, Zhou CY, Ma L, Wang XC, Zhang C, Jiang Q. Traditional Chinese Medicine Qingre Huoxue Treatment vs. the Combination of Methotrexate and Hydroxychloroquine for Active Rheumatoid Arthritis: A Multicenter, Double-Blind, Randomized Controlled Trial. Front Pharmacol 2021; 12:679588. [PMID: 34113254 PMCID: PMC8186316 DOI: 10.3389/fphar.2021.679588] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/10/2021] [Indexed: 12/24/2022] Open
Abstract
Traditional Chinese medicine (TCM) has been used successfully to treat rheumatoid arthritis (RA). Qingre Huoxue treatment (Qingre Huoxue decoction (QRHXD)/Qingre Huoxue external preparation (QRHXEP)) is a therapeutic scheme of TCM for RA. To date, there have been few studies comparing the efficacy and safety of QRHXD and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) for the treatment of active RA. This was investigated in a multicenter, double-blind, randomized controlled trial involving 468 Chinese patients with active RA [disease activity score (DAS)-28 > 3.2] treated with QRHXD/QRHXEP (TCM group), methotrexate plus hydroxychloroquine [Western medicine (WM) group], or both [integrative medicine (IM) group]. Patients were followed up for 24 weeks. The primary outcome measure was the change in DAS-28 from baseline to 24 weeks. The secondary outcome measures were treatment response rate according to American College of Rheumatology 20, 50, and 70% improvement criteria (ACR-20/50/70) and the rate of treatment-related adverse events (TRAEs). The trial was registered at ClinicalTrials.gov (NCT02551575). DAS-28 decreased in all three groups after treatment (p < 0.0001); the score was lowest in the TCM group (p < 0.05), while no difference was observed between the WM and IM groups (p > 0.05). At week 24, ACR-20 response was 73.04% with TCM, 80.17% with WM, and 73.95% with IM (based on the full analysis set [FAS], p > 0.05); ACR-50 responses were 40.87, 47.93, and 51.26%, respectively, (FAS, p > 0.05); and ACR-70 responses were 20.87, 22.31, and 25.21%, respectively, (FAS, p > 0.05). Thus, treatment efficacy was similar across groups based on ACR criteria. On the other hand, the rate of TRAEs was significantly lower in the TCM group compared to the other groups (p < 0.05). Thus, QRHXD/QRHXEP was effective in alleviating the symptoms of active RA—albeit to a lesser degree than csDMARDs—with fewer side effects. Importantly, combination with QRHXD enhanced the efficacy of csDMARDs. These results provide evidence that QRHXD can be used as an adjunct to csDMARDs for the management of RA, especially in patients who experience TRAEs with standard drugs. Clinical Trial Registration: ClinicalTrials.gov, identifier NCTNCT025515.
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Affiliation(s)
- Xun Gong
- Guang'anmen Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei-Xiang Liu
- Guang'anmen Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao-Po Tang
- Guang'anmen Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Jian Wang
- Guang'anmen Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Jian Liu
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Qing-Chun Huang
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Wei Liu
- The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yong-Fei Fang
- Affiliated Hospital of the Third Military Medical University of the Chinese People's Liberation Army, Chongqing, China
| | - Dong-Yi He
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Ying Liu
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ming-Li Gao
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shandong, China
| | - Qing-Jun Wu
- Peking Union Medical College Hospital, Beijing, China
| | - Shi Chen
- Peking University People's Hospital, Beijing, China
| | - Zhen-Bin Li
- Bethune International Peace Hospital, Shijiazhuang, China
| | - Yue Wang
- Jiangsu Provincial Hospital of Traditional Chinese Medicine, Beijing, China
| | - Yan-Ming Xie
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | | | - Cai-Yun Zhou
- Xiyuan Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Li Ma
- China-Japan Friendship Hospital, Beijing, China
| | - Xin-Chang Wang
- The Second Affiliated Hospital of Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Chi Zhang
- Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Quan Jiang
- Guang'anmen Hospital China Academy of Chinese Medical Sciences, Beijing, China
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Cai X, Chen XM, Xia X, Bao K, Wang RR, Peng JH, Liu HJ, Yang QW, Yan JY, Wang MJ, Yu H, Lu JJ, Hu YJ, Jakobsson PJ, Wen ZH, Huang RY, Huang QC. The Bone-Protecting Efficiency of Chinese Medicines Compared With Western Medicines in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis of Comparative Studies. Front Pharmacol 2018; 9:914. [PMID: 30233362 PMCID: PMC6134841 DOI: 10.3389/fphar.2018.00914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/25/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Rheumatoid Arthritis (RA) is a systemic autoimmune disease leading to joint destruction. The prevention of bone and cartilage destruction has received increased attention in recent years. Objective: To evaluate the current evidences regarding the bone-protecting efficacy of Chinese medicine or the combination of Chinese medicine and Western medicine for RA. Methods: We comprehensively searched PubMed, Embase, the Cochrane Library (www.thecochranelibrary.com), the China National Knowledge Infrastructure (CNKI), the Database for Chinese Technical Periodicals (VIP), and SinoMed. We then performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) assessing the two therapy methods. Results: Sixteen studies including 1,171 patients were included in the final analysis. The results showed that Chinese medicine could significantly improve the bone mineral density (BMD) (mean difference [MD] = 0.05 /g·cm-2, 95% CI [0.03, 0.08], P < 0.00001), and decrease the serum matrix metalloproteinase 3 (MMP-3) ([SMD] = -2.84, 95% CI [-4.22, -1.47], P < 0.0001). Conclusions: Chinese medicine may provide an efficiently alternative choice for the treatment of RA in terms of the bone-protecting efficiency. Given the inherent limitations of the included studies, future well-designed RCTs are required to confirm and update the findings of this analysis.
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Affiliation(s)
- Xiao Cai
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xiu-Min Chen
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xuan Xia
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Kun Bao
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Rong-Rong Wang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jian-Hong Peng
- Department of Rheumatology, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, China
| | - Hai-Jun Liu
- Department of Rheumatology, Panyu District Central Hospital, Guangzhou, China
| | - Qiao-Wen Yang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jing-Yao Yan
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Mao-Jie Wang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- University Medicial Center Utrecht, Utrecht, Netherlands
| | - Hua Yu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau
| | - Jin-Jian Lu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau
| | - Yuan-Jia Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau
| | - Per-Johan Jakobsson
- Rheumatology Unit, Department of Medicine, Karolinska Institutet and Rheumatology Clinic, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Ze-Huai Wen
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Run-Yue Huang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China
| | - Qing-Chun Huang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Liu Z, Huang Y, Cui Z, Tan Y, Yang J, Lü A, Wang Y, Jiang M. Application of Traditional Chinese Medicine in medical practice: a survey of community residents in Beijing, China. J TRADIT CHIN MED 2018; 37:261-8. [PMID: 29961274 DOI: 10.1016/s0254-6272(17)30053-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate how community residents in Beijing understood and used Traditional
Chinese Medicine (TCM) in their medical practice. METHODS This was a cross-sectional study conducted on 3410 community residents from four
large communities of Tongzhou district in Beijng, China. A validated, self-administered questionnaire
comprised of three sections was used to gather the data. A systematic sampling procedure was applied
to recruit the community residents. RESULTS A total of 3410 participants completed the questionnaire survey. It showed that in highly
educated residents, 33.4% (170) knew of the names of 3-10 Chinese herbals, 35.8% (182) knew of
names of 3-10 traditional Chinese patent drug. Among all the respondent residents, 80.7% (2753)
believed that TCM herbal therapy and TCM non-drug treatments were effective in disease
treatment, health enhancement, 85.7% (2923) had taken traditional Chinese patent drug in their life,
56.8% (1937) of residents had used herbal decoction, 40.0% (1365) had received non-drug treatment
of TCM, such as acupuncture, massage, cupping, auricular acupuncture. Among the elderly residents,
11.4% (98) often used Chinese patent drug and 9.8% (85) often used herbal decoction. In addition,
70.8% (2415) of residents were willing to accept knowledge and information on TCM for health
enhancement and disease prevention, such as medicated diet, medicinal tea, Tai Chi and Qi Gong, although
82.8% (2825) of residents had never used them. CONCLUSION Chinese patent drug and herbal decoction are widely used in the communities in Beijing,
and there existed a possible close correlation between high educational level and better understanding
of TCM. Age and occupation also correlated with the attitude to TCM therapies. The characteristics
of the residents should be considered seriously in the course of promoting the understanding
and application of TCM.
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Pan X, Lopez-Olivo MA, Song J, Pratt G, Suarez-Almazor ME. Systematic review of the methodological quality of controlled trials evaluating Chinese herbal medicine in patients with rheumatoid arthritis. BMJ Open 2017; 7:e013242. [PMID: 28249848 PMCID: PMC5353312 DOI: 10.1136/bmjopen-2016-013242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES We appraised the methodological and reporting quality of randomised controlled clinical trials (RCTs) evaluating the efficacy and safety of Chinese herbal medicine (CHM) in patients with rheumatoid arthritis (RA). DESIGN For this systematic review, electronic databases were searched from inception until June 2015. The search was limited to humans and non-case report studies, but was not limited by language, year of publication or type of publication. Two independent reviewers selected RCTs, evaluating CHM in RA (herbals and decoctions). Descriptive statistics were used to report on risk of bias and their adherence to reporting standards. Multivariable logistic regression analysis was performed to determine study characteristics associated with high or unclear risk of bias. RESULTS Out of 2342 unique citations, we selected 119 RCTs including 18 919 patients: 10 108 patients received CHM alone and 6550 received one of 11 treatment combinations. A high risk of bias was observed across all domains: 21% had a high risk for selection bias (11% from sequence generation and 30% from allocation concealment), 85% for performance bias, 89% for detection bias, 4% for attrition bias and 40% for reporting bias. In multivariable analysis, fewer authors were associated with selection bias (allocation concealment), performance bias and attrition bias, and earlier year of publication and funding source not reported or disclosed were associated with selection bias (sequence generation). Studies published in non-English language were associated with reporting bias. Poor adherence to recommended reporting standards (<60% of the studies not providing sufficient information) was observed in 11 of the 23 sections evaluated. LIMITATIONS Study quality and data extraction were performed by one reviewer and cross-checked by a second reviewer. Translation to English was performed by one reviewer in 85% of the included studies. CONCLUSIONS Studies evaluating CHM often fail to meet expected methodological criteria, and high-quality evidence is lacking.
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Affiliation(s)
- Xin Pan
- Department of Rheumatology, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Maria A Lopez-Olivo
- Department of General Internal Medicine, Rheumatology Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gregory Pratt
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Rheumatology Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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