1
|
Costantini E, Masciarelli E, Casorri L, Di Luigi M, Reale M. Medicinal herbs and multiple sclerosis: Overview on the hard balance between new therapeutic strategy and occupational health risk. Front Cell Neurosci 2022; 16:985943. [PMID: 36439198 PMCID: PMC9688751 DOI: 10.3389/fncel.2022.985943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease characterized by demyelination and axonal loss of the central nervous system (CNS). Despite its spread throughout the world, the mechanisms that determine its onset are still to be defined. Immunological, genetic, viral, and environmental factors and exposure to chemicals may trigger MS. Many studies have highlighted the anti-inflammatory and anti-oxidant effects of medicinal herbs, which make them a natural and complementary treatment for neurodegenerative diseases. A severe reduction of several MS symptoms occurs with herbal therapy. Thus, the request for medicinal plants with potential beneficial effects, for MS patients, is constantly increasing. Consequently, a production increase needs. Unfortunately, many medicinal herbs were untested and their action mechanism, possible adverse effects, contraindications, or interactions with other drugs, are poorly or not investigated. Keeping in mind the pathological mechanisms of MS and the oxidative damages and mitochondrial dysfunctions induced by pesticides, it is important to understand if pesticides used to increase agricultural productivity and their residues in medicinal plants, may increase the risk of developing MS in both workers and consumers. Studies providing some indication about the relationship between environmental exposure to pesticides and MS disease incidence are few, fragmentary, and discordant. The aim of this article is to provide a glance at the therapeutic potential of medicinal plants and at the risk for MS onset of pesticides used by medicinal plant growers and present in medicinal herbs.
Collapse
Affiliation(s)
- Erica Costantini
- Department of Medicine and Science of Aging, G. d’Annunzio University of Chieti–Pescara, Chieti, Italy
| | - Eva Masciarelli
- Department of Technological Innovations and Safety of Plants, Products and Anthropic Settlements, National Institute for Insurance Against Accidents at Work, Rome, Italy
| | - Laura Casorri
- Department of Technological Innovations and Safety of Plants, Products and Anthropic Settlements, National Institute for Insurance Against Accidents at Work, Rome, Italy
| | - Marco Di Luigi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL Research Center, National Institute for Insurance Against Accidents at Work, Rome, Italy
| | - Marcella Reale
- Department of Innovative Technologies in Medicine and Dentistry, G. d’Annunzio University of Chieti–Pescara, Chieti, Italy
- *Correspondence: Marcella Reale,
| |
Collapse
|
2
|
Abd-Elhakim YM, Al-Sagheer AA. Opuntia spp. Benefits in Chronic Diseases. OPUNTIA SPP.: CHEMISTRY, BIOACTIVITY AND INDUSTRIAL APPLICATIONS 2021:423-455. [DOI: 10.1007/978-3-030-78444-7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
3
|
Csupor D, Lantos T, Hegyi P, Benkő R, Viola R, Gyöngyi Z, Csécsei P, Tóth B, Vasas A, Márta K, Rostás I, Szentesi A, Matuz M. Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complement Ther Med 2019; 47:102190. [PMID: 31780016 DOI: 10.1016/j.ctim.2019.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022] Open
Abstract
Although chasteberry (Vitex agnus-castus, VAC) has been studied in several clinical trials and available as medicine for the alleviation of premenstrual syndrome (PMS) symptoms, the efficacy of properly characterised preparations has not been assessed in meta-analyses. The aim of our work was to evaluate the efficacy of VAC in PMS. The meta-analysis was performed following the PRISMA guidelines using the PICOS format, taking into account the CONSORT recommendations. PubMed, Embase, the Cochrane Central Register of Controlled Trials and Web of Science were searched for studies on VAC. The analysis assessed the efficacy of properly characterised products VAC compared to a placebo for the alleviation of PMS symptoms in terms of responder rate, considering the decrease of Total Symptom Score or PMS Diary score. The random effects model was used to calculate summary relative risk (RR) and 95% confidence interval (CI). Only those randomised, double-blind, placebo-controlled trials were included that fulfilled the criteria of the CONSORT recommendations aiming at the proper characterization of herbal products. Out of the 21 clinical trials, three studies (520 females) fulfilled the inclusion criteria, comparing the efficacy of special extracts Ze 440 and BNO 1095 to a placebo for the treatment of PMS. VAC preparations were confirmed to be effective in the reduction of PMS symptoms: women taking VAC were 2.57 (95% CI 1.52-4.35) times more likely to experience a remission in their symptoms compared to those taking the placebo. Although several clinical trials have been carried out with VAC, the majority of the studies cannot be used as evidence for efficacy due to incomplete reporting, especially concerning the description of the used medication. More trials following the CONSORT recommendations are needed to assess the efficacy of VAC extracts.
Collapse
Affiliation(s)
- Dezső Csupor
- Department of Pharmacognosy, University of Szeged, H-6720 Szeged, Hungary; Interdisciplinary Centre for Natural Products, University of Szeged, H-6720 Szeged, Hungary.
| | - Tamás Lantos
- Department of Medical Physics and Informatics, University of Szeged, H-6720 Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, University of Pécs, H-7624 Pécs, Hungary; Translational Gastroenterology Research Group, Hungarian Academy of Sciences, University of Szeged, H-6720 Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, University of Szeged, H-6725 Szeged, Hungary
| | - Réka Viola
- Translational Gastroenterology Research Group, Hungarian Academy of Sciences, University of Szeged, H-6720 Szeged, Hungary
| | - Zoltán Gyöngyi
- Department of Public Health Medicine, University of Pécs, H-7624 Pécs, Hungary
| | - Péter Csécsei
- Department of Neurology, University of Pécs, H-7623 Pécs, Hungary
| | - Barbara Tóth
- Department of Pharmacognosy, University of Szeged, H-6720 Szeged, Hungary; Interdisciplinary Centre for Natural Products, University of Szeged, H-6720 Szeged, Hungary
| | - Andrea Vasas
- Department of Pharmacognosy, University of Szeged, H-6720 Szeged, Hungary; Interdisciplinary Centre for Natural Products, University of Szeged, H-6720 Szeged, Hungary
| | - Katalin Márta
- Institute for Translational Medicine, University of Pécs, H-7624 Pécs, Hungary
| | - Ildikó Rostás
- Institute for Translational Medicine, University of Pécs, H-7624 Pécs, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, University of Pécs, H-7624 Pécs, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, H-6725 Szeged, Hungary.
| |
Collapse
|
4
|
Aracil A, Green J. Plants with antimalarial properties: A systematic review of the current clinical evidence. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
Sajadimajd S, Bahrami G, Daglia M, Nabavi SM, Naseri R, Farzaei MH. Plant-Derived Supplementary Carbohydrates, Polysaccharides and Oligosaccharides in Management of Diabetes Mellitus: A Comprehensive Review. FOOD REVIEWS INTERNATIONAL 2019. [DOI: 10.1080/87559129.2019.1584818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Soraya Sajadimajd
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Gholamreza Bahrami
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maria Daglia
- Department of Drug Sciences, Medicinal Chemistry and Pharmaceutical Technology Section, University of Pavia, Pavia, Italy
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Rozita Naseri
- Internal Medicine Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
6
|
Jin Y, Sanger N, Shams I, Luo C, Shahid H, Li G, Bhatt M, Zielinski L, Bantoto B, Wang M, Abbade LP, Nwosu I, Leenus A, Mbuagbaw L, Maaz M, Chang Y, Sun G, Levine MA, Adachi JD, Thabane L, Samaan Z. Does the medical literature remain inadequately described despite having reporting guidelines for 21 years? - A systematic review of reviews: an update. J Multidiscip Healthc 2018; 11:495-510. [PMID: 30310289 PMCID: PMC6166749 DOI: 10.2147/jmdh.s155103] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Reporting guidelines (eg, Consolidated Standards of Reporting Trials [CONSORT] statement) are intended to improve reporting standards and enhance the transparency and reproducibility of research findings. Despite accessibility of such guidelines, researchers are not required to adhere to them. Our goal was to determine the current status of reporting quality in the medical literature and examine whether adherence of reporting guidelines has improved since the inception of reporting guidelines. MATERIALS AND METHODS Eight reporting guidelines, such as CONSORT, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), Quality of Reporting of Meta-analysis (QUOROM), STAndards for Reporting of Diagnostic accuracy (STARD), Animal Research: Reporting In Vivo Experiments (ARRIVE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were examined. Our inclusion criteria included reviews published between January 1996 to September 2016 which investigated the adherence to reporting guidelines in the literature that addressed clinical trials, systematic reviews, observational studies, meta-analysis, diagnostic accuracy, economic evaluations, and preclinical animal studies that were in English. All reviews were found on Web of Science, Excerpta Medical Database (EMBASE), MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). RESULTS Among the general searching of 26,819 studies by using the designed searching method, 124 studies were included post screening. We found that 87.9% of the included studies reported suboptimal adherence to reporting guidelines. Factors associated with poor adherence included non-pharmacological interventions, year of publication, and trials concluding with significant results. Improved adherence was associated with better study designs such as allocation concealment, random sequence, large sample sizes, adequately powered studies, multiple authorships, and being published in journals endorsing guidelines. CONCLUSION We conclude that the level of adherence to reporting guidelines remains suboptimal. Endorsement of reporting guidelines by journals is important and recommended.
Collapse
Affiliation(s)
- Yanling Jin
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Nitika Sanger
- Department of Medical Science, Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Ieta Shams
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Candice Luo
- Faculty of Health Sciences, Bachelors of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Hamnah Shahid
- Department of Arts and Science, McMaster University, Hamilton, ON, Canada
| | - Guowei Li
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Meha Bhatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Laura Zielinski
- Department of Neuroscience, McMaster Integrative Neuroscience Discovery and Study, McMaster University, Hamilton, ON, Canada
| | - Bianca Bantoto
- Department of Science, Honours Integrated Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Mei Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Luciana Pf Abbade
- Department of Dermatology and Radiotherapy, Botucatu Medical School, Universidade Estadual Paulista, UNESP, São Paulo, Brazil
| | - Ikunna Nwosu
- Faculty of Health Sciences, Bachelors of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alvin Leenus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Muhammad Maaz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Yaping Chang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Guangwen Sun
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Mitchell Ah Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Jonathan D Adachi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada,
| |
Collapse
|
7
|
Aruwa CE, Amoo SO, Kudanga T. Opuntia (Cactaceae) plant compounds, biological activities and prospects - A comprehensive review. Food Res Int 2018; 112:328-344. [PMID: 30131144 DOI: 10.1016/j.foodres.2018.06.047] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/19/2023]
Abstract
Opuntia species are utilized as local medicinal interventions for chronic diseases and as food sources mainly because they possess nutritional properties and biological activities. The Opuntia plant is distributed worldwide and has great economic potential. Differences in Opuntia species phytochemical composition exist between wild and domesticated species, and within species. Opuntia aerial and underground parts exhibit beneficial properties due to their phenolic content, other antioxidants (for example ascorbate), pigments (carotenoids, betalains), and other unidentified components. This work comprehensively reviews the phytochemical composition of the different aerial and underground plant parts of Opuntia species. The applications of Opuntia compounds and their biological activities are also discussed. Other topical aspects covered include Opuntia spp. taurine composition, Opuntia side effects, Opuntia by-products valorisation and the role of Opuntia spp. in tackling antimicrobial resistance. Although biological activities have been extensively researched, much less information is available on reaction mechanisms, herbal mixtures toxicology and commercialisation prospects - aspects which should be considered for future research in this area.
Collapse
Affiliation(s)
- Christiana Eleojo Aruwa
- Department of Biotechnology and Food Technology, Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa
| | - Stephen O Amoo
- Agricultural Research Council, Roodeplaat Vegetable and Ornamental Plants, Private Bag X293, Pretoria 0001, South Africa
| | - Tukayi Kudanga
- Department of Biotechnology and Food Technology, Durban University of Technology, P.O. Box 1334, Durban 4000, South Africa.
| |
Collapse
|
8
|
Quality of reporting of randomized controlled trials of herbal medicines conducted in metabolic disorders in Middle East countries: A systematic review. Complement Ther Med 2018; 38:61-66. [PMID: 29857881 DOI: 10.1016/j.ctim.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/11/2018] [Indexed: 01/31/2023] Open
|
9
|
Enhancing primary reports of randomized controlled trials: Three most common challenges and suggested solutions. Proc Natl Acad Sci U S A 2018. [PMID: 29531032 DOI: 10.1073/pnas.1708286114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Evidence from a well-designed randomized controlled trial (RCT) is generally considered to be the gold standard that can inform clinical practice and guide decision-making. However, several deficiencies in the reporting of RCTs have frequently been identified, including incomplete, selective, and biased or inconsistent reporting. Such suboptimal reporting may lead to irreproducible results, substantial waste of resources, impaired study validity, erosion of public trust in science, and a high risk of research misconduct. In this article, we present an overview of the reporting of RCTs in the biomedical literature with a focus on the three most common reporting problems: (i) lack of adherence to reporting guidelines, (ii) inconsistencies between trial protocols or registrations and full reports, and (iii) inconsistencies between abstracts and their corresponding full reports. Unsatisfactory levels of adherence to guidelines and frequent inconsistencies between protocols or registrations and full reports, and between abstracts and full reports, were consistently found in various biomedical research fields. A variety of factors were found to be associated with these reporting challenges. Improved reporting can build public trust and credibility of science, save resources, and enhance the ethical integrity of research. Therefore, joint efforts from the various sectors of the biomedical community (researchers, journal editors and reviewers, educators, healthcare providers, and other research consumers) are needed to reduce and reverse the current suboptimal state of RCT reporting in the literature.
Collapse
|
10
|
Chrubasik-Hausmann S, Vlachojannis J, McLachlan AJ. Understanding drug interactions with St John's wort (Hypericum perforatum L.): impact of hyperforin content. J Pharm Pharmacol 2018; 71:129-138. [DOI: 10.1111/jphp.12858] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 10/24/2017] [Indexed: 02/03/2023]
Abstract
Abstract
Objective
The aim of this study was to review herb–drug interaction studies with St John's wort (Hypericum perforatum L.) with a focus on the hyperforin content of the extracts used in these studies.
Methods
PUBMED was systematically searched to identify studies describing pharmacokinetic interactions involving St John's wort. Data on study design and the St John's wort extract or product were gathered to extract hyperforin content and daily dose used in interaction studies.
Key findings
This analysis demonstrates that significant herb–drug interactions (resulting in a substantial change in systemic exposure) with St John's wort products were associated with hyperforin daily dosage. Products that had a daily dose of <1 mg hyperforin were less likely to be associated with major interaction for drugs that were CYP3A4 or p-glycoprotein substrates. Although a risk of interactions cannot be excluded even for low-dose hyperforin St. John's wort extracts, the use of products that result in a dose of not more than 1 mg hyperforin per day is recommended to minimise the risk of interactions.
Conclusions
This review highlights that the significance of herb–drug interactions with St John's wort is influenced by the nature of the herbal medicines product, particularly the hyperforin content.
Collapse
Affiliation(s)
| | - Julia Vlachojannis
- Institute of Forensic Medicine, University of Freiburg, Freiburg, Germany
| | - Andrew J McLachlan
- Centre for Education and Research on Ageing, Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| |
Collapse
|
11
|
Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients 2018; 10:nu10010041. [PMID: 29300341 PMCID: PMC5793269 DOI: 10.3390/nu10010041] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 01/14/2023] Open
Abstract
Many of the scientific and regulatory challenges that exist in research on the safety, quality and efficacy of dietary supplements are common to all countries as the marketplace for them becomes increasingly global. This article summarizes some of the challenges in supplement science and provides a case study of research at the Office of Dietary Supplements at the National Institutes of Health, USA, along with some resources it has developed that are available to all scientists. It includes examples of some of the regulatory challenges faced and some resources for those who wish to learn more about them.
Collapse
Affiliation(s)
- Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517, USA.
| | - Paul M Coates
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517, USA.
| | - Michael J Smith
- National Center for Natural Products Research, University of Mississippi, MS 38677, USA.
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia.
| |
Collapse
|
12
|
Kuriyama A, Endo K. Goshajinkigan for prevention of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Support Care Cancer 2017; 26:1051-1059. [PMID: 29280005 DOI: 10.1007/s00520-017-4028-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) limits the dose of chemotherapy and reduces patients' quality of life. Goshajinkigan is a Japanese herbal medicine used to alleviate neuropathy and general pain. A clinical guideline for prevention and management of CIPN stated that the prophylactic efficacy of goshajinkigan against CIPN was inconclusive. We conducted a systematic review to examine whether goshajinkigan prevents CIPN in patients receiving neurotoxic chemotherapy. METHODS We searched PubMed, EMBASE, Ichushi, and the Cochrane Central Register of Controlled Trials for eligible trials. Randomized controlled trials that examined the efficacy and safety of goshajinkigan for prevention of CIPN were included. Our primary outcomes were incidence of CIPN, response to chemotherapy, and adverse effects. We pooled data using a random effects model. RESULTS We analyzed five trials involving a total of 397 patients. When evaluated with Neurotoxicity Criteria of Debiopharm, goshajinkigan was associated with reduced incidence of CIPN of grade ≥ 1 (risk ratio [RR] 0.43; 95% CI, 0.27 to 0.66) and grade 3 (RR 0.42; 95% CI, 0.25 to 0.71), but this beneficial association was not found for grade ≥ 2 of CIPN. Goshajinkigan was not associated with reduced incidence of CIPN when assessed with the National Cancer Institute Common Terminology Criteria for Adverse Events, or improved response to chemotherapy. Goshajinkigan was well tolerated based on one trial. CONCLUSIONS Goshajinkigan is unlikely to prevent CIPN in patients undergoing neurotoxic chemotherapy. Given the low quality and insufficient amount of the evidence, use of goshajinkigan as standard of care is not currently recommended.
Collapse
Affiliation(s)
- Akira Kuriyama
- Department of General Medicine, Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki, Okayama, 710-8602, Japan.
| | - Koji Endo
- Department of General Internal Medicine, Tottori Prefectural Central Hospital, 730 Ezu Tottori, Tottori, 680-0901, Japan
| |
Collapse
|
13
|
Okumu MO, Ochola FO, Onyango AO, Mbaria JM, Gakuya DW, Kanja LW, Kiama SG, Onyango MA. The legislative and regulatory framework governing herbal medicine use and practice in Kenya: a review. Pan Afr Med J 2017; 28:232. [PMID: 29629018 PMCID: PMC5882212 DOI: 10.11604/pamj.2017.28.232.12585] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/06/2017] [Indexed: 11/11/2022] Open
Abstract
Complementary and alternative medicine is an integral component of primary healthcare in Kenya. This is because the infrastructural health setup in the country is inadequate in catering for all the medical needs of the population. This particularly holds true in the rural areas where many rural folk rely on products of herbal origin to offset their healthcare needs. More often than not these products are an elaborate cacophony of several different substances of biological origin and thus need personnel adept in their preparation. Sadly, due to loopholes in legislation and regulation, quacks have a field day in the practice. Moreover, the process of planting, harvesting, preparation and storage of herbs and related products dictates that a significant number of people will ultimately be involved in the whole process. This is likely to set the stage for manipulation and compromise of the safety, quality and efficacy of these products. This state of affairs appears unabated especially in the context of the current legal and regulatory framework governing herbal medicine use and practice in Kenya. Not only are these laws inadequate, they are shrouded in ambiguity, open to interpretation and the authorities mandated to implement them often end up performing duplicate roles. The aim of this review is to critique the legal and regulatory provisions governing herbal medicine use and practice in Kenya. In conclusion, laws and regulations meant to control herbal medicine use and practice in Kenya are wanting. Clear and definitive legislation on herbal medicine use and practice coupled with effective implementation by mandated institutions will go a long way in inspiring confidence to all stakeholders of herbal medicine.
Collapse
Affiliation(s)
- Mitchel Otieno Okumu
- Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, P.O BOX 29053-00625 Nairobi, Kenya
| | - Francis Okumu Ochola
- Department of Pharmacology and Toxicology, Faculty of Medicine, Moi University, P.O BOX 3900-30100 Eldoret, Kenya
| | - Allan Odhiambo Onyango
- Onyango Allan and Company Advocates, 3Floor, Pioneer House, P.O BOX 50485-00100 Nairobi, Kenya
| | - James Mucunu Mbaria
- Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, P.O BOX 29053-00625 Nairobi, Kenya
| | - Daniel Waweru Gakuya
- Department of Clinical Studies, Faculty of Veterinary Medicine, University of Nairobi, P.O BOX 29053-00625 Nairobi, Kenya
| | - Laetitia Wakonyu Kanja
- Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, P.O BOX 29053-00625 Nairobi, Kenya
| | - Stephen Gitahi Kiama
- Department of Veterinary Anatomy and Physiology, Faculty of Veterinary Medicine, University of Nairobi, P.O BOX 29053-00625 Nairobi, Kenya
| | - Mary Atieno Onyango
- Department of Pharmacology, School of Medicine, Maseno University, P.O BOX Private bag, Maseno, Kenya
| |
Collapse
|
14
|
Abstract
Aim: The purpose of this review is to summarize and evaluate the current status of clinical research on the use of Chinese herbal medicine in treating cancer pain, with emphasis on the efficacy and safety of the applications. Method: A search of the clinical research published between 1986 and 2006 on the effects and applications of Chinese herbal medicine in cancer pain management was conducted using databases of CBM, CMCC, Wanfang, and Weipu (available since 1989) in Chinese and PubMed and EMBASE in English. We included only reports of original publications on cancer-induced pain, resulting in a total of 115 articles. We evaluated the methodological quality of the articles following the guidelines set forth as “Levels of Evidence of Human Studies of Cancer in Complementary and Alternative Medicine” by the National Cancer Institute. Results: Various methods of traditional Chinese medicine herbal treatment for cancer pain management have been reported. These methods include external application, oral administration, intravenous infusion, and other applications such as inhalation and clysmata. Forty-one of the 115 studies reviewed were randomized controlled clinical trials, most comparing the effects of Chinese herbal medicine to conventional analgesics and the others using placebo controls. These trials suggest that (1) Chinese medicine may be effective for cancer pain, and its effects are similar to those of Western analgesics; (2) Chinese medicine may reduce the side effects of conventional analgesics, thus enhancing cancer patients' quality of life; and (3) the various methods of application—topical, oral, and intravenous—are suitable to treat a range of pain conditions found in cancer patients. However, trials were of varying quality with respect to control group selection, dosing and side effect information, and outcome measures. Conclusion: The studies reviewed in this article suggest that Chinese herbal medicine may be useful for managing cancer pain, at least for short-term application. The products evaluated appear relatively safe, with no serious adverse effects reported. However, the quality of the published reports is variable. More research using rigorously controlled clinical trial design is warranted.
Collapse
Affiliation(s)
- Ling Xu
- Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | | | | | | | | | | |
Collapse
|
15
|
Saldanha LG, Dwyer JT, Betz JM. Culinary Spice Plants in Dietary Supplement Products and Tested in Clinical Trials. Adv Nutr 2016; 7:343-8. [PMID: 26980817 PMCID: PMC4785482 DOI: 10.3945/an.115.011213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Dried plant parts used as culinary spices (CSs) in food are permitted as dietary ingredients in dietary supplements (DSs) within certain constraints in the United States. We reviewed the amounts, forms, and nutritional support (structure/function) claims of DSs that contain CS plants listed in the Dietary Supplement Label Database (DSLD) and compared this label information with trial doses and health endpoints for CS plants that were the subject of clinical trials listed in clinicaltrials.gov. According to the DSLD, the CS plants occurring most frequently in DSs were cayenne, cinnamon, garlic, ginger, pepper, rosemary, and turmeric. Identifying the botanical species, categorizing the forms used, and determining the amounts from the information provided on DS labels was challenging. CS plants were typically added as a component of a blend, as the powered biomass, dried extracts, and isolated phytochemicals. The amounts added were declared on about 55% of the labels, rendering it difficult to determine the amount of the CS plant used in many DSs. Clinicaltrials.gov provided little information about the composition of test articles in the intervention studies. When plant names were listed on DS labels and in clinical trials, generally the common name and not the Latin binomial name was given. In order to arrive at exposure estimates and enable researchers to reproduce clinical trials, the Latin binomial name, form, and amount of the CS plant used in DSs and tested in clinical trials must be specified.
Collapse
Affiliation(s)
- Leila G Saldanha
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD
| | | | | |
Collapse
|
16
|
Dhingra K, Vandana KL. Effectiveness of Azadirachta indica (neem) mouthrinse in plaque and gingivitis control: a systematic review. Int J Dent Hyg 2016; 15:4-15. [PMID: 26876277 DOI: 10.1111/idh.12191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this systematic review was to evaluate the effectiveness of Azadirachta indica (neem)-based herbal mouthrinse in improving plaque control and gingival health. METHODS Literature search was accomplished using electronic databases (PubMed, Cochrane Central Register of Controlled Trials and EMBASE) and manual searching, up to February 2015, for randomized controlled trials (RCTs) presenting clinical data for efficacy of neem mouthrinses when used alone or as an adjunct to mechanical oral hygiene as compared to chlorhexidine mouthrinses for controlling plaque and gingival inflammation in patients with gingivitis. RESULTS Of the total 206 articles searched, three randomized controlled trials evaluating neem-based herbal mouthrinses were included. Due to marked heterogeneity observed in study characteristics, meta-analysis was not performed. These studies reported that neem mouthrinse was as effective as chlorhexidine mouthrinse when used as an adjunct to toothbrushing in reducing plaque and gingival inflammation in gingivitis patients. However, the quality of reporting and evidence along with methods of studies was generally flawed with unclear risk of bias. CONCLUSION Despite the promising results shown in existing randomized controlled trials, the evidence concerning the clinical use of neem mouthrinses is lacking and needs further reinforcement with high-quality randomized controlled trials based on the reporting guidelines of herbal CONSORT statement.
Collapse
Affiliation(s)
- K Dhingra
- Department of Periodontology, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - K L Vandana
- Department of Periodontology and Implantology, College of Dental Sciences, Davangere, Karnataka, India
| |
Collapse
|
17
|
Kim KI, Shin S, Lee N, Lee BJ, Lee J, Lee H. A traditional herbal medication, Maekmoondong-tang, for cough: A systematic review and meta-analysis. JOURNAL OF ETHNOPHARMACOLOGY 2016; 178:144-154. [PMID: 26666732 DOI: 10.1016/j.jep.2015.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/26/2015] [Accepted: 12/04/2015] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Maekmoondong-tang (MMDT) is a traditional herbal medication widely used to improve cough in Korea, Japan, and China. It is composed of six herbs (Ophiopogonis Tuber, Pinelliae Tuber, Glycyrrhizae Radix, Zizyphi Fructus, Ginseng Radix, and Oryzae Semen). AIM OF THE STUDY This study is aimed to systematically review the relevant randomised controlled trials (RCTs) to determine the effectiveness and safety of MMDT for cough. MATERIALS AND METHODS Electronic and hand-searching of 7 databases (Cochrane Library, MEDLINE, EMBASE, OASIS, RISS, CNKI and CiNii) was systematically conducted up to February 2015 for RCTs testing MMDT in patients with cough. The primary outcome was cough symptom improvement using cough diary, visual analog scale, or response rate. Risk of bias of the included trials was evaluated with the Cochrane risk of bias assessment tool. The dichotomous data were pooled to obtain a risk ratio (RR) of cough persisting after treatment, with 95% confidence intervals (CI). RESULTS Nine RCTs involving 2453 participants were included. The methodological quality was largely poor for a majority of the studies. MMDT reduced the severity of cough by 74% compared with the conventional antitussive medications in various conditions (n=1145; RR of cough persisting after treatment=0.26; 95% CI, 0.19-0.34, I(2)=0%). The addition of MMDT to conventional medication in patients with postinfectious cough significantly alleviated symptoms up to day 5 but the effect was not maintained one week afterwards. For other diseases/conditions including chronic obstructive pulmonary disease, lung cancer surgery, and asthma, the evidence is inconsistent for MMDT/mMMDT for cough. Adverse events appear to be rare but the reporting was poor. CONCLUSIONS The current evidence from our systematic review and meta-analysis on MMDT for cough is inconclusive and we propose that rigorously designed, placebo-controlled trials of MMDT should be conducted to establish its place in management of cough.
Collapse
Affiliation(s)
- Kwan-Il Kim
- Department of Clinical Korean Medicine, College of Korean Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Republic of Korea.
| | - Seungwon Shin
- College of Korean Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Republic of Korea.
| | - Nara Lee
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Republic of Korea.
| | - Beom-Joon Lee
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Republic of Korea.
| | - Junhee Lee
- College of Korean Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Republic of Korea.
| | - Hyangsook Lee
- Acupuncture & Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
| |
Collapse
|
18
|
Kuszak AJ, Hopp DC, Williamson JS, Betz JM, Sorkin BC. Approaches by the US National Institutes of Health to support rigorous scientific research on dietary supplements and natural products. Drug Test Anal 2016; 8:413-7. [PMID: 26768111 DOI: 10.1002/dta.1931] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 11/13/2015] [Accepted: 11/14/2015] [Indexed: 11/06/2022]
Abstract
Mechanistic, clinical, and epidemiological research relevant to dietary supplements (DS) is supported by the U.S. National Institutes of Health. The Office of Dietary Supplements and the National Center for Complementary and Integrative Health promote the development and appropriate use of rigorous and comprehensive DS analyses which are critical for research reproducibility, particularly when the investigational DS include chemically complex natural products with unclear mechanisms of action.
Collapse
Affiliation(s)
- A J Kuszak
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD, 20892-7517, USA
| | - D C Hopp
- Division of Extramural Research, National Center for Complementary and Integrative Health, National Institutes of Health, 6707 Democracy Blvd., Bethesda, MD, 20892, USA
| | - J S Williamson
- Division of Extramural Research, National Center for Complementary and Integrative Health, National Institutes of Health, 6707 Democracy Blvd., Bethesda, MD, 20892, USA
| | - J M Betz
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD, 20892-7517, USA
| | - B C Sorkin
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD, 20892-7517, USA
| |
Collapse
|
19
|
Zhao X, Zhen Z, Guo J, Zhao T, Ye R, Guo Y, Chen H, Lian F, Tong X. Assessment of the Reporting Quality of Placebo-controlled Randomized Trials on the Treatment of Type 2 Diabetes With Traditional Chinese Medicine in Mainland China: A PRISMA-Compliant Systematic Review. Medicine (Baltimore) 2016; 95:e2522. [PMID: 26817893 PMCID: PMC4998267 DOI: 10.1097/md.0000000000002522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Placebo-controlled randomized trials are often used to evaluate the absolute effect of new treatments and are considered gold standard for clinical trials. No studies, however, have yet been conducted evaluating the reporting quality of placebo-controlled randomized trials. The current study aims to assess the reporting quality of placebo-controlled randomized trials on treatment of diabetes with Traditional Chinese Medicine (TCM) in Mainland China and to provide recommendations for improvements.China National Knowledge Infrastructure database, Wanfang database, China Biology Medicine database, and VIP database were searched for placebo-controlled randomized trials on treatment of diabetes with TCM. Review, animal experiment, and randomized controlled trials without placebo control were excluded. According to Consolidated Standards of Reporting Trials (CONSORT) 2010 checklists items, each item was given a yes or no depending on whether it was reported or not.A total of 68 articles were included. The reporting percentage in each article ranged from 24.3% to 73%, and 30.9% articles reported more than 50% of the items. Seven of the 37 items were reported more than 90% of the items, whereas 7 items were not mentioned at all. The average reporting for "title and abstract," "introduction," "methods," "results," "discussion," and "other information" was 43.4%, 78.7%, 40.1%, 49.9%, 71.1%, and 17.2%, respectively. The percentage of each section had increased after 2010. In addition, the reporting of multiple study centers, funding, placebo species, informed consent forms, and ethical approvals were 14.7%, 50%, 36.85%, 33.8%, and 4.4%, respectively.Although a scoring system was created according to the CONSORT 2010 checklist, it was not designed as an assessment tool. According to CONSORT 2010, the reporting quality of placebo-controlled randomized trials on the treatment of diabetes with TCM improved after 2010. Future improvements, however, are still needed, particularly in methods sections.
Collapse
Affiliation(s)
- Xiyan Zhao
- From the Department of Endocrinology, China Academy of Chinese Medical Sciences, Guang'anmen Hospital (XZ, ZZ, JG, RY, HC, FL, XT); Graduate School, Beijing University of Chinese Medicine, Beijing (XZ, RY); Department of Endocrinology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin (TZ); and Department of Endocrinology, Dongzhimen Hospital Eastern Affiliated to Beijing University of Chinese Medicine, Beijing, China (YG)
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Gagnier JJ, Oltean H, van Tulder MW, Berman BM, Bombardier C, Robbins CB. Herbal Medicine for Low Back Pain: A Cochrane Review. Spine (Phila Pa 1976) 2016; 41:116-33. [PMID: 26630428 DOI: 10.1097/brs.0000000000001310] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review of randomized controlled trials (RCTs). OBJECTIVES To determine the effectiveness of herbal medicine for nonspecific low back pain (LBP). SUMMARY OF BACKGROUND DATA Many people with chronic LBP use complementary and alternative medicine (CAM), visit CAM practitioners, or both. Several herbal medicines have been purported for use in treating people with LBP. This is an update of a Cochrane Review first published in 2006. METHODS We searched numerous electronic databases up to September 2014; checked reference lists in review articles, guidelines and retrieved trials; and personally contacted individuals with expertise in this area. We included RCTs examining adults (over 18 years of age) suffering from acute, sub-acute, or chronic nonspecific LBP. The interventions were herbal medicines that we defined as plants used for medicinal purposes in any form. Primary outcome measures were pain and function. Two review authors assessed risk of bias, GRADE criteria (GRADE 2004), and CONSORT compliance and a random subset were compared with assessments by a third individual. Two review authors assessed clinical relevance and resolved any disagreements by consensus. RESULTS Fourteen RCTs (2050 participants) were included. Capsicum frutescens (cayenne) reduces pain more than placebo. Although Harpagophytum procumbens (devil's claw), Salix alba (white willow bark), Symphytum officinale L. (comfrey), Solidago chilensis (Brazilian arnica), and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best. No significant adverse events were noted within the included trials. CONCLUSIONS Additional well-designed large trials are needed to test these herbal medicines against standard treatments. In general, the completeness of reporting in these trials was poor. Trialists should refer to the CONSORT statement extension for reporting trials of herbal medicine interventions. LEVEL OF EVIDENCE N/A.
Collapse
Affiliation(s)
- Joel J Gagnier
- *Departments of Orthopaedic Surgery, Ann Arbor, MI†Epidemiology, University of Michigan, Ann Arbor, MI‡Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands§Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD‖Institute for Work & Health, Toronto, ON, Canada
| | | | | | | | | | | |
Collapse
|
21
|
Liu XT, Zhang X, Wen S, Peng L, Hong Q, Kang D. Impact of the Consolidated Standards of Reporting Trials (CONSORT) checklist on reporting of randomized clinical trials in traditional Chinese medicine. J Evid Based Med 2015; 8:192-208. [PMID: 26334556 DOI: 10.1111/jebm.12173] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/03/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the reporting characteristics and key methodological factors of randomized controlled trials (RCTs) in the field of traditional Chinese medicine and assess whether use of the Consolidated Standards of Reporting Trials (CONSORT) statement is associated with improvement in the quality of reports of RCTs. METHOD RCTs published in two major traditional Chinese medicine journals were retrieved and were systematically reviewed. Of those journals, one adopted the CONSORT statement (Journal of Chinese Integrative Medicine (JCIM)) and one did not (Chinese Journal of Integrative Medicine (CJIM)). Items within the CONSORT 2001 and the CONSORT 2010 statements were taken to develop a 63-item coding manual. The Jadad scale was also used to assess methodological quality of RCTs. Two observers assessed the reporting of reports and extracted data independently. P < 0.05 was considered statistically significant. SPSS was used for all analyses. RESULTS A total of 76 RCTs were included for the analysis (38 from JCIM and 38 from CJIM). Significant improvements both in the overall quality of reporting (CONSORT score) and reporting of methodological items (Jadad scale) over time were observed in adopter journal (JCIM) (P = 0.001). Overall CONSORT score of studies published during 2010 to 2011 (post-CONSORT) increased 15.30 averagely with 95%CI 8.34 to 22.26 (P = 0.001). Of those, items addressed on reporting of methodological quality were different significantly too. JCIM had more 1.30 items addressed than CJIM in average (95% CI 0.52 to 2.08, P = 0.003). In the multivariate analysis regression, the page length and CONSORT-promoting status have statistically significant associated with the (P = 0.001 and P = 0.040, respectively). CONCLUSION Although a large room needs to improve the reporting of randomized clinical trials in traditional Chinese medicine, the impact for improvement of reporting of TCM RCTs has been proven in some extent.
Collapse
Affiliation(s)
| | | | - Shu Wen
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Le Peng
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Hong
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Deying Kang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
22
|
The relevance of pharmacognosy in pharmacological research on herbal medicinal products. Epilepsy Behav 2015; 52:344-62. [PMID: 26169932 DOI: 10.1016/j.yebeh.2015.05.037] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/22/2015] [Accepted: 05/23/2015] [Indexed: 01/27/2023]
Abstract
As all medicines, herbal medicinal products are expected to be safe, effective, and of appropriate quality. However, regulations on herbal medicinal products vary from country to country, and herbal preparations do occur not only in the form of medicinal products but also as less strictly regulated product groups like dietary supplements. Therefore, it is not always easy for the consumers to discriminate high-quality products from low-quality products. On the other hand, herbal medicines have many special features that distinguish them from conventional medicinal products. Plants are complex multicomponent mixtures; in addition, their phytochemical composition is not constant because of inherent variability and a plethora of external influences. Therefore, the production process of an herbal medicinal product needs to be strictly monitored. First of all, the starting materials need to be correctly authenticated and free of adulterants and contaminants. During plant growth, many factors like harvest season and time, developmental stage, temperature, and humidity have a strong impact on plant metabolite production. Also, postharvest processing steps like drying and storage can significantly alter the phytochemical composition of herbal material. As the production of many phytopharmaceuticals includes an extraction step, the extraction solvent and conditions need to be optimized in order to enrich the bioactive constituents in the extract. The quality of finished preparations needs to be determined either on the basis of marker constituents or on the basis of analytical fingerprints. Thus, all production stages should be accompanied by appropriate quality assessment measures. Depending on the particular task, different methods need to be applied, ranging from macroscopic, microscopic, and DNA-based authentication methods to spectroscopic methods like vibrational spectroscopy and chromatographic and hyphenated methods like HPLC, GC-MS and LC-MS. Also, when performing pharmacological and toxicological studies, many features inherent in herbal medicinal products need to be considered in order to guarantee valid results: concerning in vitro studies, difficulties are often related to lacking knowledge of ADME characteristics of the bioactive constituents, nuisance compounds producing false positive and false negative results, and solubility problems. In in vivo animal studies, the route of administration is a very important issue. Clinical trials on herbal medicinal products in humans very often suffer from a poor reporting quality. This often hampers or precludes the pooling of clinical data for systematic reviews. In order to overcome this problem, appropriate documentation standards for clinical trials on herbal medicinal products have been defined in an extension of the CONSORT checklist. This article is part of a Special Issue entitled "Botanicals for Epilepsy".
Collapse
|
23
|
Turi CE, Finley J, Shipley PR, Murch SJ, Brown PN. Metabolomics for phytochemical discovery: development of statistical approaches using a cranberry model system. JOURNAL OF NATURAL PRODUCTS 2015; 78:953-966. [PMID: 25751407 DOI: 10.1021/np500667z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Metabolomics is the qualitative and quantitative analysis of all of the small molecules in a biological sample at a specific time and influence. Technologies for metabolomics analysis have developed rapidly as new analytical tools for chemical separations, mass spectrometry, and NMR spectroscopy have emerged. Plants have one of the largest metabolomes, and it is estimated that the average plant leaf can contain upward of 30 000 phytochemicals. In the past decade, over 1200 papers on plant metabolomics have been published. A standard metabolomics data set contains vast amounts of information and can either investigate or generate hypotheses. The key factors in using plant metabolomics data most effectively are the experimental design, authentic standard availability, extract standardization, and statistical analysis. Using cranberry (Vaccinium macrocarpon) as a model system, this review will discuss and demonstrate strategies and tools for analysis and interpretation of metabolomics data sets including eliminating false discoveries and determining significance, metabolite clustering, and logical algorithms for discovery of new metabolites and pathways. Together these metabolomics tools represent an entirely new pipeline for phytochemical discovery.
Collapse
Affiliation(s)
- Christina E Turi
- †Department of Chemistry, University of British Columbia, 3247 University Way, Kelowna, British Columbia, Canada, V1V 1V7
| | - Jamie Finley
- ‡Natural Health Products and Food Research Group, British Columbia Institute of Technology, 4355 Mathissi Place, Burnaby, British Columbia, Canada, V5G 3H2
| | - Paul R Shipley
- †Department of Chemistry, University of British Columbia, 3247 University Way, Kelowna, British Columbia, Canada, V1V 1V7
| | - Susan J Murch
- †Department of Chemistry, University of British Columbia, 3247 University Way, Kelowna, British Columbia, Canada, V1V 1V7
| | - Paula N Brown
- ‡Natural Health Products and Food Research Group, British Columbia Institute of Technology, 4355 Mathissi Place, Burnaby, British Columbia, Canada, V5G 3H2
| |
Collapse
|
24
|
Pratoomsoot C, Sruamsiri R, Dilokthornsakul P, Chaiyakunapruk N. Quality of reporting of randomised controlled trials of herbal interventions in ASEAN Plus Six Countries: a systematic review. PLoS One 2015; 10:e108681. [PMID: 25633206 PMCID: PMC4310614 DOI: 10.1371/journal.pone.0108681] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 09/02/2014] [Indexed: 01/15/2023] Open
Abstract
Background Many randomised controlled trials (RCTs) of herbal interventions have been conducted in the ASEAN Communities. Good quality reporting of RCTs is essential for assessing clinical significance. Given the importance ASEAN placed on herbal medicines, the reporting quality of RCTs of herbal interventions among the ASEAN Communities deserved a special attention. Objectives To systematically review the quality of reporting of RCTs of herbal interventions conducted in the ASEAN Plus Six Countries. Methods Searches were performed using PubMed, EMBASE, The Cochrane Library, and Allied and Complementary Medicine (AMED), from inception through October 2013. These were limited to studies specific to humans and RCTs. Herbal species search terms were based on those listed in the National List of Essential Medicines [NLEM (Thailand, 2011)]. Studies conducted in the ASEAN Plus Six Countries, published in English were included. Results Seventy-one articles were identified. Thirty (42.25%) RCTs were from ASEAN Countries, whereas 41 RCTs (57.75%) were from Plus Six Group. Adherence to the recommended CONSORT checklist items for reporting of RCTs of herbal interventions among ASEAN Plus Six Countries ranged from 0% to 97.18%. Less than a quarter of the RCTs (18.31%) reported information on standardisation of the herbal products. However, the scope of our interventions of interest was limited to those developed from 20 herbal species listed in the NLEM of Thailand. Conclusions The present study highlights the need to improve reporting quality of RCTs of herbal interventions across ASEAN Plus Six Communities.
Collapse
Affiliation(s)
| | - Rosarin Sruamsiri
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- Department of Population Medicine, Drug Policy Research Group, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- Center for Pharmacoepidemiology and Pharmacoeconomic Research and Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
- School of Population Health, Public Health Building, University of Queensland, Herston, Australia
- School of Pharmacy, University of Wisconsin, Madison, WI, United States of America
- * E-mail:
| |
Collapse
|
25
|
Oltean H, Robbins C, van Tulder MW, Berman BM, Bombardier C, Gagnier JJ. Herbal medicine for low-back pain. Cochrane Database Syst Rev 2014; 2014:CD004504. [PMID: 25536022 PMCID: PMC7197042 DOI: 10.1002/14651858.cd004504.pub4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Low-back pain (LBP) is a common condition and imposes a substantial economic burden upon people living in industrialized societies. A large proportion of people with chronic LBP use complementary and alternative medicine (CAM), visit CAM practitioners, or both. Several herbal medicines have been purported for use in treating people with LBP. This is an update of a Cochrane Review first published in 2006. OBJECTIVES To determine the effectiveness of herbal medicine for non-specific LBP. SEARCH METHODS We searched the following electronic databases up to September 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, Clinical Trials.gov, World Health Organization International Clinical Trials Registry Portal and PubMed; checked reference lists in review articles, guidelines and retrieved trials; and personally contacted individuals with expertise in this area. SELECTION CRITERIA We included randomized controlled trials (RCTs) examining adults (over 18 years of age) suffering from acute, sub-acute, or chronic non-specific LBP. The interventions were herbal medicines which we defined as plants used for medicinal purposes in any form. Primary outcome measures were pain and function. DATA COLLECTION AND ANALYSIS A library scientist with the Cochrane Back Review Group conducted the database searches. One review author contacted content experts and acquired relevant citations. We downloaded full references and abstracts of the identified studies and retrieved a hard copy of each study for final inclusion decisions. Two review authors assessed risk of bias, GRADE criteria (GRADE 2004), and CONSORT compliance and a random subset were compared to assessments by a third individual. Two review authors assessed clinical relevance and resolved any disagreements by consensus. MAIN RESULTS We included 14 RCTs (2050 participants) in this review. One trial on Solidago chilensis M. (Brazilian arnica) (20 participants) found very low quality evidence of reduction in perception of pain and improved flexibility with application of Brazilian arnica-containing gel twice daily as compared to placebo gel. Capsicum frutescens cream or plaster probably produces more favourable results than placebo in people with chronic LBP (three trials, 755 participants, moderate quality evidence). Based on current evidence, it is not clear whether topical capsicum cream is more beneficial for treating people with acute LBP compared to placebo (one trial, 40 participants, low quality evidence). Another trial found equivalence of C. frutescens cream to a homeopathic ointment (one trial, 161 participants, very low quality evidence). Daily doses of Harpagophytum procumbens (devil's claw), standardized to 50 mg or 100 mg harpagoside, may be better than placebo for short-term improvements in pain and may reduce use of rescue medication (two trials, 315 participants, low quality evidence). Another H. procumbens trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (Vioxx®) but was of very low quality (one trial, 88 participants, very low quality). Daily doses of Salix alba (white willow bark), standardized to 120 mg or 240 mg salicin, are probably better than placebo for short-term improvements in pain and rescue medication (two trials, 261 participants, moderate quality evidence). An additional trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (one trial, 228 participants) but was graded as very low quality evidence. S. alba minimally affected platelet thrombosis versus a cardioprotective dose of acetylsalicylate (one trial, 51 participants). One trial (120 participants) examining Symphytum officinale L. (comfrey root extract) found low quality evidence that a Kytta-Salbe comfrey extract ointment is better than placebo ointment for short-term improvements in pain as assessed by VAS. Aromatic lavender essential oil applied by acupressure may reduce subjective pain intensity and improve lateral spine flexion and walking time compared to untreated participants (one trial, 61 participants,very low quality evidence). No significant adverse events were noted within the included trials. AUTHORS' CONCLUSIONS C. frutescens (Cayenne) reduces pain more than placebo. Although H. procumbens, S. alba, S. officinale L., S. chilensis, and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best. Additional well-designed large trials are needed to test these herbal medicines against standard treatments. In general, the completeness of reporting in these trials was poor. Trialists should refer to the CONSORT statement extension for reporting trials of herbal medicine interventions.
Collapse
Affiliation(s)
- Hanna Oltean
- University of MichiganDepartment of Orthopaedic Surgery24 Frank Lloyd Wright DrAnn ArborMIUSA48106
| | - Chris Robbins
- University of MichiganDepartment of Orthopaedic Surgery24 Frank Lloyd Wright DrAnn ArborMIUSA48106
| | - Maurits W van Tulder
- VU UniversityDepartment of Health Sciences, Faculty of Earth and Life SciencesPO Box 7057Room U454AmsterdamNetherlands1007 MB
| | - Brian M Berman
- University of Maryland School of MedicineCenter for Integrative Medicine520 W. Lombard St2nd FloorBaltimoreMarylandUSA21201
| | - Claire Bombardier
- Institute for Work & Health481 University Avenue, Suite 800TorontoONCanadaM5G 2E9
| | - Joel J Gagnier
- University of MichiganDepartment of Epidemiology, School of Public Health1415 Washington HeightsRm M5158Ann ArborMIUSA48109‐2029
| | | |
Collapse
|
26
|
Nyakudya E, Jeong JH, Lee NK, Jeong YS. Platycosides from the Roots of Platycodon grandiflorum and Their Health Benefits. Prev Nutr Food Sci 2014; 19:59-68. [PMID: 25054103 PMCID: PMC4103729 DOI: 10.3746/pnf.2014.19.2.059] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/10/2014] [Indexed: 11/06/2022] Open
Abstract
The extracts and pure saponins from the roots of Platycodon grandiflorum (PG) are reported to have a wide range of health benefits. Platycosides (saponins) from the roots of PG are characterized by a structure containing a triterpenoid aglycone and two sugar chains. Saponins are of commercial significance, and their applications are increasing with increasing evidence of their health benefits. The biological effects of saponins include cytotoxic effects against cancer cells, neuroprotective activity, antiviral activity, and cholesterol lowering effects. Saponins with commercial value range from crude plant extracts, which can be used for their foaming properties, to high purity saponins such as platycodin D, which can be used for its health applications (e.g., as a vaccine adjuvant). This review reveals that platycosides have many health benefits and have the potential to be used as a remedy against many of the major health hazards (e.g., cancer, obesity, alzheimer's) faced by populations around the world. Methods of platycoside purification and analysis are also covered in this review.
Collapse
Affiliation(s)
- Elijah Nyakudya
- Research Center for Industrial Development of Biofood Materials, Chonbuk National University, Jeonbuk 561-756, Korea ; Department of Food Science and Technology, Chonbuk National University, Jeonbuk 561-756, Korea
| | - Jong Hoon Jeong
- Research Center for Industrial Development of Biofood Materials, Chonbuk National University, Jeonbuk 561-756, Korea
| | - Nam Keun Lee
- Research Center for Industrial Development of Biofood Materials, Chonbuk National University, Jeonbuk 561-756, Korea
| | - Yong-Seob Jeong
- Department of Food Science and Technology, Chonbuk National University, Jeonbuk 561-756, Korea
| |
Collapse
|
27
|
Zhong YQ, Fu JJ, Liu XM, Diao X, Mao B, Fan T, Yang HM, Liu GJ, Zhang WB. The reporting quality, scientific rigor, and ethics of randomized placebo-controlled trials of traditional Chinese medicine compound formulations and the differences between Chinese and non-Chinese trials. CURRENT THERAPEUTIC RESEARCH 2014; 71:30-49. [PMID: 24683249 DOI: 10.1016/j.curtheres.2010.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND An increasing number of randomized placebo-controlled trials involving traditional Chinese medicine (TCM) compound formulations have been implemented worldwide. OBJECTIVE The aim of this study was to assess the reporting quality, scientific rigor, and ethics of randomized placebo-controlled trials of TCM compound formulations and compare these differences between Chinese and non-Chinese trials. METHODS English-language databases included the following: PubMed, OVID, EMBASE, and Science Citation Index Expanded. Chinese-language databases included the following: Chinese Biomedical Literature Database, Wanfang Database, Chinese Scientific and Technological Periodical Database, and the China National Knowledge Infrastructure. All were searched from respective inception to March 2009 to identify randomized placebo-controlled trials involving TCM compound prescriptions. Two reviewers independently assessed the retrieved trials via a modified Consolidated Standard of Reporting Trials (CONSORT) checklist and some evaluation indices that embodied the TCM characteristics or the scientific rigor and ethics of placebo-controlled trials. Trial publishing time was divided into 3 intervals: phase 1 (≤1999); phase 2 (2000-2004); and phase 3 (2005-2009). The number and percentage of trials reporting each item and the corresponding differences between Chinese (mainland China, Hong Kong, and Taiwan) and non-Chinese (eg, Japan, United States, Australia, Korea, and United Kingdom) trials were calculated. Moreover, the influence of trial publishing time on the reporting of CONSORT items and the differences in the number of items reported for each time interval between Chinese and non-Chinese trials were assessed. RESULTS A total of 324 trials from China and 51 trials from other countries were included. A mean of 39.7% of the CONSORT items across all Chinese trials and 50.2% of the items across all non-Chinese trials were reported. The number of the reported CONSORT items all increased over time in both groups and the gap between Chinese articles and non-Chinese articles gradually decreased. Additionally, of the 324 Chinese articles, 137 (42.28%) reported TCM syndrome type, 113 (34.88%) reported the diagnostic criteria of diseases for TCM, and 69 (21.30%) reported efficacy evaluation indices of TCM. Of the non-Chinese articles, 3 (5.88%) reported TCM syndrome type and 1 (1.96%) reported the diagnostic criteria of diseases and evaluation indices of efficacy for TCM. It was found that 45.37% and 6.17% of Chinese articles reported the standard intervention for the diseases being treated and the emergency plan, respectively, compared with 23.53% and 9.80% for the non-Chinese articles; 33.02% and 10.49% of Chinese articles reported informed consent and ethics committee approval, respectively, compared with 92.16% and 82.35% for the non-Chinese articles. With regard to placebo ethics, 38.89% of the Chinese trials and 23.53% of the non-Chinese trials found it would not be ethically acceptable to use placebo alone in the control group. CONCLUSIONS The data indicate that the reporting quality of the included trials on TCM compounds has improved over time, but still remains poor regardless of Chinese or non-Chinese trials. Across all trials, particularly Chinese trials, the reporting of the CONSORT items was inadequate (39.7%). The difference in the mean number of the reported CONSORT items between Chinese trials and non-Chinese trials narrowed from phase 1 (10.0 vs 13.8) to phase 3 (14.4 vs 17.4). Moreover, a large number of trials, especially non-Chinese trials (94.1%), were lacking syndrome differentiation of TCM. More importantly, in many placebo-controlled trials, especially Chinese trials, the use of placebo was not justified and was ethically contradictory.
Collapse
Affiliation(s)
- Yun-Qing Zhong
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Juan-Juan Fu
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xue-Mei Liu
- Chinese Evidence-Based Medicine/Cochrane Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xiang Diao
- Chinese Evidence-Based Medicine/Cochrane Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Bing Mao
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Tao Fan
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Hong-Mei Yang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Guan-Jian Liu
- Chinese Evidence-Based Medicine/Cochrane Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wen-Bin Zhang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| |
Collapse
|
28
|
Wheatley VM, Spink J. Defining the Public Health Threat of Dietary Supplement Fraud. Compr Rev Food Sci Food Saf 2013; 12:599-613. [PMID: 33412717 DOI: 10.1111/1541-4337.12033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 06/24/2013] [Indexed: 11/26/2022]
Abstract
Adverse health events resulting from dietary supplement fraud (DSF)-fraud conducted for economic gain using dietary supplements-have received increased recognition from agencies and industry. There is a growing awareness that this issue represents a significant public health threat. With increasing consumption of supplements, there are increasing consequences-good and bad-for food science and food safety. "Dietary supplements" are a special category of food that consists of finished products (for example, a vitamin D tablet) that contain 1 or more dietary ingredients. "Dietary ingredients" are the components of those finished products (for example, vitamin D added to a food product such as breakfast cereal). Due to a number of factors, potentially harmful dietary supplements reach-and often remain-in the market. DSF is a type of product fraud, as is food fraud, which is often classified by the U.S. Food and Drug Administration as Economically Motivated Adulteration (EMA). Since the adulterants are unconventional, DSF may represent an even greater public health threat than traditional dietary supplement safety issues (though it is important to note that adulteration is only one type of fraud). Criminology concepts such as situational crime prevention and the crime triangle deepen understanding of the relationship of fraud opportunity as it relates to fraudsters and established hurdles to fraud. The purpose of this research is to provide a comprehensive overview on the public health threat of DSF, and to focus on altering current intervention and response-based approaches that are prevention-based.
Collapse
Affiliation(s)
| | - John Spink
- Food Fraud Initiative, Dept. of School of Large Animal and Clinical Sciences, College of Veterinary Medicine, Michigan State Univ., East Lansing, MI, 48824, U.S.A
| |
Collapse
|
29
|
Shergis JL, Zhang AL, Zhou W, Xue CC. Quality and risk of bias in Panax ginseng randomized controlled trials: a review. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2013; 41:231-52. [PMID: 23548116 DOI: 10.1142/s0192415x13500171] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Panax ginseng is one of the most frequently used herbs in the world. Numerous trials have evaluated its clinical benefits. However, the quality of these studies has not been comprehensively and systematically assessed. We reviewed randomized controlled trials (RCTs) of Panax ginseng to evaluate their quality and risk of bias. We searched four English databases, without publication date restriction. Two reviewers extracted details about the studies' methodological quality, guided by the Consolidated Standards of Reporting Trials (CONSORT) checklist and its extension for herbal interventions. Risk of bias was determined using the Cochrane Risk of Bias tool. Of 475 potentially relevant studies, 58 met our inclusion criteria. In these 58 studies, 48.3% of the suggested CONSORT checklist items and 35.9% of the extended herbal items were reported. The quality of RCTs published after the CONSORT checklist improved. Until 1995 (before CONSORT) (n = 4), 32.8% of the items were reported in studies. From 1996-2006 (CONSORT published and revised) (n = 30), 46.1% were reported, and from 2007 (n = 24), 53.5% were reported (p = 0.005). After the CONSORT extension for herbal interventions was published in 2006, RCT quality also improved, although not significantly. Until 2005 (n = 34), 35.2% of the extended herbal items were reported in studies; and from 2006 onwards (n = 24), 37.3% were reported (p = 0.64). Most studies classified risk of bias as "unclear". Overall, the quality of Panax ginseng RCT methodology has improved since the CONSORT checklist was introduced. However, more can be done to improve the methodological quality of, and reporting in, RCTs.
Collapse
Affiliation(s)
- Johannah L Shergis
- Traditional and Complementary Medicine Research Program, School of Health Sciences and Health Innovations Research Institute (HIRi), RMIT University, Bundoora, VIC 3083, Australia
| | | | | | | |
Collapse
|
30
|
Therapeutic applications of herbal medicines for cancer patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:302426. [PMID: 23956768 PMCID: PMC3727181 DOI: 10.1155/2013/302426] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 06/17/2013] [Accepted: 06/19/2013] [Indexed: 12/12/2022]
Abstract
Medicinal herbs and their derivative phytocompounds are being increasingly recognized as useful complementary treatments for cancer. A large volume of clinical studies have reported the beneficial effects of herbal medicines on the survival, immune modulation, and quality of life (QOL) of cancer patients, when these herbal medicines are used in combination with conventional therapeutics. Here, we briefly review some examples of clinical studies that investigated the use of herbal medicines for various cancers and the development of randomized controlled trials (RCTs) in this emerging research area. In addition, we also report recent studies on the biochemical and cellular mechanisms of herbal medicines in specific tumor microenvironments and the potential application of specific phytochemicals in cell-based cancer vaccine systems. This review should provide useful technological support for evidence-based application of herbal medicines in cancer therapy.
Collapse
|
31
|
Samaan Z, Mbuagbaw L, Kosa D, Borg Debono V, Dillenburg R, Zhang S, Fruci V, Dennis B, Bawor M, Thabane L. A systematic scoping review of adherence to reporting guidelines in health care literature. J Multidiscip Healthc 2013; 6:169-88. [PMID: 23671390 PMCID: PMC3649856 DOI: 10.2147/jmdh.s43952] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Reporting guidelines have been available for the past 17 years since the inception of the Consolidated Standards of Reporting Trials statement in 1996. These guidelines were developed to improve the quality of reporting of studies in medical literature. Despite the widespread availability of these guidelines, the quality of reporting of medical literature remained suboptimal. In this study, we assess the current adherence practice to reporting guidelines; determine key factors associated with better adherence to these guidelines; and provide recommendations to enhance adherence to reporting guidelines for future studies. Methods We undertook a systematic scoping review of systematic reviews of adherence to reporting guidelines across different clinical areas and study designs. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase, and Medline) from January 1996 to September 2012. Studies were included if they addressed adherence to one of the following guidelines: Consolidated Standards of Reporting Trials (CONSORT), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Quality of Reporting of Meta-analysis (QUOROM), Transparent Reporting of Evaluations with Nonrandomized Designs (TREND), Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). A protocol for this study was devised. A literature search, data extraction, and quality assessment were performed independently by two authors in duplicate. This study reporting follows the PRISMA guidelines. Results Our search retrieved 5159 titles, of which 50 were eligible. Overall, 86.0% of studies reported suboptimal levels of adherence to reporting guidelines. Factors associated with better adherence included journal impact factor and endorsement of guidelines, publication date, funding source, multisite studies, pharmacological interventions and larger studies. Conclusion Reporting guidelines in the clinical literature are important to improve the standards of reporting of clinical studies; however, adherence to these guidelines remains suboptimal. Action is therefore needed to enhance the adherence to these standards. Strategies to enhance adherence include journal editorial policies endorsing these guidelines.
Collapse
Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Population Genomics Program, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Dhingra K. Aloe vera herbal dentifrices for plaque and gingivitis control: a systematic review. Oral Dis 2013; 20:254-67. [PMID: 23607360 DOI: 10.1111/odi.12113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 01/03/2013] [Accepted: 03/27/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of aloe vera containing herbal dentifrices in improving plaque control and gingival health. METHODS A manual and electronic literature (MEDLINE and Cochrane Central Register of Controlled Trials) search was performed up to July 2012, for randomized controlled trials presenting clinical, microbiological, immunological, and patient-centered data for the efficacy of aloe vera herbal dentifrices for controlling plaque and gingival inflammation in patients with gingivitis. RESULTS From 79 titles and abstracts, eight full-text articles were screened and finally two randomized controlled trials were selected. These randomized controlled trials reported that aloe vera dentifrices were similar in efficacy to control dentifrices in effectively reducing plaque and gingival inflammation in gingivitis patients based on the assessment of clinical, microbiological, and patient-centered treatment outcomes. However, many important details (composition and characteristics of aloe vera and control dentifrices along with appropriate randomization, blinding, and outcomes assessed) were lacking in these trials, and therefore, the quality of reporting and methods was generally flawed with high risk of bias. CONCLUSION Even though there are some promising results, the clinical effectiveness of aloe vera herbal dentifrices is not sufficiently defined at present and warrants further investigations based on reporting guidelines of herbal CONSORT statement.
Collapse
Affiliation(s)
- K Dhingra
- Department of Periodontology and Implantology, Bangalore Institute of Dental Sciences and Postgraduate Research Centre, Bangalore, Karnataka, India
| |
Collapse
|
33
|
Gagnier JJ, Moher D, Boon H, Bombardier C, Beyene J. An empirical study using permutation-based resampling in meta-regression. Syst Rev 2012; 1:18. [PMID: 22587815 PMCID: PMC3351721 DOI: 10.1186/2046-4053-1-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 02/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In meta-regression, as the number of trials in the analyses decreases, the risk of false positives or false negatives increases. This is partly due to the assumption of normality that may not hold in small samples. Creation of a distribution from the observed trials using permutation methods to calculate P values may allow for less spurious findings. Permutation has not been empirically tested in meta-regression. The objective of this study was to perform an empirical investigation to explore the differences in results for meta-analyses on a small number of trials using standard large sample approaches verses permutation-based methods for meta-regression. METHODS We isolated a sample of randomized controlled clinical trials (RCTs) for interventions that have a small number of trials (herbal medicine trials). Trials were then grouped by herbal species and condition and assessed for methodological quality using the Jadad scale, and data were extracted for each outcome. Finally, we performed meta-analyses on the primary outcome of each group of trials and meta-regression for methodological quality subgroups within each meta-analysis. We used large sample methods and permutation methods in our meta-regression modeling. We then compared final models and final P values between methods. RESULTS We collected 110 trials across 5 intervention/outcome pairings and 5 to 10 trials per covariate. When applying large sample methods and permutation-based methods in our backwards stepwise regression the covariates in the final models were identical in all cases. The P values for the covariates in the final model were larger in 78% (7/9) of the cases for permutation and identical for 22% (2/9) of the cases. CONCLUSIONS We present empirical evidence that permutation-based resampling may not change final models when using backwards stepwise regression, but may increase P values in meta-regression of multiple covariates for relatively small amount of trials.
Collapse
Affiliation(s)
- Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - David Moher
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Claire Bombardier
- Health-Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Beyene
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
34
|
Karmazyn M, Moey M, Gan XT. Therapeutic potential of ginseng in the management of cardiovascular disorders. Drugs 2012; 71:1989-2008. [PMID: 21985167 DOI: 10.2165/11594300-000000000-00000] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Although employed in Asian societies for thousands of years, the use of ginseng as an herbal medication for a variety of disorders has increased tremendously worldwide in recent years. Ginseng belongs to the genus Panax, of which there exists a variety, generally reflecting their geographic origin. North American ginseng (Panax quinquefolius) and Asian ginseng (Panax ginseng) are two such varieties possessing a plethora of pharmacological properties, which are attributed primarily to the presence of different ginsenosides that bestow these ginsengs with distinct pharmacodynamic profiles. The many cardiovascular benefits attributed to ginseng include cardioprotection, antihypertensive effects, and attenuation of myocardial hypertrophy and heart failure. Experimental studies have revealed a number of beneficial properties of ginseng, particularly in the area of cardiac protection, where ginseng and ginsenosides have been shown to protect the ischaemic and reperfused heart in a variety of experimental models. Emerging evidence also suggests that ginseng attenuates myocardial hypertrophy, thus blunting the remodelling and heart failure processes. However, clinical evidence of efficacy is not convincing, likely owing primarily to the paucity of well designed, randomized, controlled clinical trials. Adding to the complexity in understanding the cardiovascular effects of ginseng is the fact that each of the different ginseng varieties possesses distinct cardiovascular properties, as a result of their respective ginsenoside composition, rendering it difficult to assign a general, common cardiovascular effect to ginseng. Additional challenges include the identification of mechanisms (likely multifaceted) that account for the effects of ginseng and determining which ginsenoside(s) mediate these cardiovascular properties. These concerns notwithstanding, the potential cardiovascular benefit of ginseng is worthy of further studies in view of its possible development as a cardiovascular therapeutic agent, particularly as adjunctive therapy to existing medications.
Collapse
Affiliation(s)
- Morris Karmazyn
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
| | | | | |
Collapse
|
35
|
Zhong Y, Zhou W, Jiang H, Fan T, Diao X, Yang H, Min J, Wang G, Fu J, Mao B. Quality of reporting of two-group parallel randomized controlled clinical trials of multi-herb formulae: A survey of reports indexed in the Science Citation Index Expanded. Eur J Integr Med 2011. [DOI: 10.1016/j.eujim.2011.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
36
|
Brown PN, Chan M, Paley L, Betz JM. Determination of major phenolic compounds in Echinacea spp. raw materials and finished products by high-performance liquid chromatography with ultraviolet detection: single-laboratory validation matrix extension. J AOAC Int 2011; 94:1400-10. [PMID: 22165004 PMCID: PMC3586990 DOI: 10.5740/jaoacint.11-142] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A method previously validated to determine caftaric acid, chlorogenic acid, cynarin, echinacoside, and cichoric acid in echinacea raw materials has been successfully applied to dry extract and liquid tincture products in response to North American consumer needs. Single-laboratory validation was used to assess the repeatability, accuracy, selectivity, LOD, LOQ, analyte stability (ruggedness), and linearity of the method, with emphasis on finished products. Repeatability precision for each phenolic compound was between 1.04 and 5.65% RSD, with HorRat values between 0.30 and 1.39 for raw and dry extract finished products. HorRat values for tinctures were between 0.09 and 1.10. Accuracy of the method was determined through spike recovery studies. Recovery of each compound from raw material negative control (ginseng) was between 90 and 114%, while recovery from the finished product negative control (maltodextrin and magnesium stearate) was between 97 and 103%. A study was conducted to determine if cichoric acid, a major phenolic component of Echinacea purpurea (L.) Moench and E. angustifolia DC, degrades during sample preparation (extraction) and HPLC analysis. No significant degradation was observed over an extended testing period using the validated method.
Collapse
Affiliation(s)
- Paula N Brown
- British Columbia Institute of Technology, 3700 Willingdon Ave, Burnaby, BC V5G 3H2, Canada.
| | | | | | | |
Collapse
|
37
|
Gagnier JJ, Moher D, Boon H, Beyene J, Bombardier C. Randomized controlled trials of herbal interventions underreport important details of the intervention. J Clin Epidemiol 2011; 64:760-9. [DOI: 10.1016/j.jclinepi.2010.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
|
38
|
Cochrane ZR, Gregory P, Wilson A. Quality of Natural Product Clinical Trials: A Comparison of Those Published in Alternative Medicine Versus Conventional Medicine Journals. J Diet Suppl 2011; 8:135-43. [DOI: 10.3109/19390211.2011.561823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
39
|
Zhang A, Xue C, Fong H. Integration of Herbal Medicine into Evidence-Based Clinical Practice. OXIDATIVE STRESS AND DISEASE 2011. [DOI: 10.1201/b10787-23] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
40
|
Girard L, Vohra S. Ethics of Using Herbal Medicine as Primary or Adjunct Treatment and Issues of Drug–Herb Interaction. OXIDATIVE STRESS AND DISEASE 2011. [DOI: 10.1201/b10787-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
41
|
|
42
|
. J, Yadav P, Chavda N, Kantharia N. Some Issues Related to the Reporting of Statistics in Clinical Trials Published in Indian Medical Journals: A Survey. INT J PHARMACOL 2010. [DOI: 10.3923/ijp.2010.354.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
43
|
Hopewell S, Dutton S, Yu LM, Chan AW, Altman DG. The quality of reports of randomised trials in 2000 and 2006: comparative study of articles indexed in PubMed. BMJ 2010; 340:c723. [PMID: 20332510 PMCID: PMC2844941 DOI: 10.1136/bmj.c723] [Citation(s) in RCA: 346] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the reporting characteristics and methodological details of randomised trials indexed in PubMed in 2000 and 2006 and assess whether the quality of reporting has improved after publication of the Consolidated Standards of Reporting Trials (CONSORT) Statement in 2001. DESIGN Comparison of two cross sectional investigations. Study sample All primary reports of randomised trials indexed in PubMed in December 2000 (n=519) and December 2006 (n=616), including parallel group, crossover, cluster, factorial, and split body study designs. MAIN OUTCOME MEASURES The proportion of general and methodological items reported, stratified by year and study design. Risk ratios with 95% confidence intervals were calculated to represent changes in reporting between 2000 and 2006. RESULTS The majority of trials were two arm (379/519 (73%) in 2000 v 468/616 (76%) in 2006) parallel group studies (383/519 (74%) v 477/616 (78%)) published in specialty journals (482/519 (93%) v 555/616 (90%)). In both 2000 and 2006, a median of 80 participants were recruited per trial for parallel group trials. The proportion of articles that reported drug trials decreased between 2000 and 2006 (from 393/519 (76%) to 356/616 (58%)), whereas the proportion of surgery trials increased (51/519 (10%) v 128/616 (21%)). There was an increase between 2000 and 2006 in the proportion of trial reports that included details of the primary outcome (risk ratio (RR) 1.18, 95% CI 1.04 to 1.33), sample size calculation (RR 1.66, 95% CI 1.40 to 1.95), and the methods of random sequence generation (RR 1.62, 95% CI 1.32 to 1.97) and allocation concealment (RR 1.40, 95% CI 1.11 to 1.76). There was no difference in the proportion of trials that provided specific details on who was blinded (RR 0.91, 95% CI 0.75 to 1.10). CONCLUSIONS Reporting of several important aspects of trial methods improved between 2000 and 2006; however, the quality of reporting remains well below an acceptable level. Without complete and transparent reporting of how a trial was designed and conducted, it is difficult for readers to assess its conduct and validity.
Collapse
Affiliation(s)
- Sally Hopewell
- Centre for Statistics in Medicine, University of Oxford, Linton Road, Oxford OX2 6UD.
| | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- Urmila Thatte
- Dept. of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai 400 012, India. E-mail:
| |
Collapse
|
45
|
Szczurko O, Boon HS. A systematic review of natural health product treatment for vitiligo. BMC DERMATOLOGY 2008; 8:2. [PMID: 18498646 PMCID: PMC2432048 DOI: 10.1186/1471-5945-8-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 05/22/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vitiligo is a hypopigmentation disorder affecting 1 to 4% of the world population. Fifty percent of cases appear before the age of 20 years old, and the disfigurement results in psychiatric morbidity in 16 to 35% of those affected. METHODS Our objective was to complete a comprehensive, systematic review of the published scientific literature to identify natural health products (NHP) such as vitamins, herbs and other supplements that may have efficacy in the treatment of vitiligo. We searched eight databases including MEDLINE and EMBASE for vitiligo, leucoderma, and various NHP terms. Prospective controlled clinical human trials were identified and assessed for quality. RESULTS Fifteen clinical trials were identified, and organized into four categories based on the NHP used for treatment. 1) L-phenylalanine monotherapy was assessed in one trial, and as an adjuvant to phototherapy in three trials. All reported beneficial effects. 2) Three clinical trials utilized different traditional Chinese medicine products. Although each traditional Chinese medicine trial reported benefit in the active groups, the quality of the trials was poor. 3) Six trials investigated the use of plants in the treatment of vitiligo, four using plants as photosensitizing agents. The studies provide weak evidence that photosensitizing plants can be effective in conjunction with phototherapy, and moderate evidence that Ginkgo biloba monotherapy can be useful for vitiligo. 4) Two clinical trials investigated the use of vitamins in the therapy of vitiligo. One tested oral cobalamin with folic acid, and found no significant improvement over control. Another trial combined vitamin E with phototherapy and reported significantly better repigmentation over phototherapy only. It was not possible to pool the data from any studies for meta-analytic purposes due to the wide difference in outcome measures and poor quality ofreporting. CONCLUSION Reports investigating the efficacy of NHPs for vitiligo exist, but are of poor methodological quality and contain significant reporting flaws. L-phenylalanine used with phototherapy, and oral Ginkgo biloba as monotherapy show promise and warrant further investigation.
Collapse
Affiliation(s)
- Orest Szczurko
- Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
| | - Heather S Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
| |
Collapse
|
46
|
Whelan AM, Jurgens TM, Lord L. Evaluating the quality of randomized controlled trials that examine the efficacy of natural health products: a systematic review of critical appraisal instruments. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2008; 6:441-8. [PMID: 18955310 PMCID: PMC2781780 DOI: 10.1093/ecam/nem186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The purpose of this project was to conduct a systematic review to identify instruments designed to evaluate the quality of randomized controlled trials (RCTs) of natural health products (NHPs). Instruments were examined for inclusion of items assessing methods, identity and content of the NHP, generalizability of results and instructions for use. Online databases, websites, textbooks and reference lists were searched to identify instruments. Relevance assessment and data extraction of articles were completed by two investigators and disagreements were settled by the third investigator. Data were analyzed using descriptive statistics. Of the 4442 citations identified, 29 were potentially relevant with 16 meeting the criteria for inclusion. None of the instruments stated they were validated; content in the four areas of interest varied considerably. The most common items included randomization sequence generation (100%), blinding (100%), allocation concealment (75%) and participant flow (75%). Only nine of the NHP instruments included at least one item to appraise the specific content of the NHP. The CONSORT Statement for Herbal Interventions most closely addressed the four areas of interest; however, this instrument was specific for herbs. There is a need for the development of a validated instrument for assessment of the quality of RCTs that would be useful for herbs as well as other NHPs.
Collapse
Affiliation(s)
- Anne Marie Whelan
- College of Pharmacy, Dalhousie University, 5968 College Street, Halifax NS, Canada B3H 3J5.
| | | | | |
Collapse
|
47
|
Xu L, Wei PK, Sun DZ, Lao L. Quality of reporting in 41 randomized controlled clinical trials of Chinese medicine for cancer pain. Shijie Huaren Xiaohua Zazhi 2007; 15:3764-3769. [DOI: 10.11569/wcjd.v15.i35.3764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To highlight the importance and necessity of quality assurance in clinical trial reporting by analyzing 41 papers on of Chinese medicine for cancer pain.
METHODS: A search for clinical trial reports published from 1986 to 2006 on the effects, mechanisms, safety and application of Chinese herbal medicine in cancer pain management was conducted using the CBM, Chinese Medical Current Contents (CMCC) and Weipu (available since 1989) databases in Chinese, and PubMed and EMBASE in English. We evaluated the methodological quality of the articles, following the guidelines set forth in Levels of Evidence of Human Studies of Cancer in Complementary and Alternative Medicine by the National Cancer Institute (NCI) and Quality of Reporting of Randomized Controlled Trials of Herbal Medicine Interventions by Gagnier et al.
RESULTS: Some research information was insufficiently reported, including methods of randomization, inclusion and exclusion criteria, outcome measurements, blinding and concealment, quality control and quality assurance of herbal preparations, and adverse events.
CONCLUSION: Two crucial elements of high quality scientific reporting are the provision of sufficient research information and the transparency of research methodology. Insufficient reporting may be one of the major reasons. Chinese medicine is not widely and globally used to treat cancer pain.
Collapse
|
48
|
Risks and benefits of commonly used herbal medicines in Mexico. Toxicol Appl Pharmacol 2007; 227:125-35. [PMID: 18037151 DOI: 10.1016/j.taap.2007.10.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 09/29/2007] [Accepted: 10/04/2007] [Indexed: 01/13/2023]
Abstract
In Mexico, local empirical knowledge about medicinal properties of plants is the basis for their use as home remedies. It is generally accepted by many people in Mexico and elsewhere in the world that beneficial medicinal effects can be obtained by ingesting plant products. In this review, we focus on the potential pharmacologic bases for herbal plant efficacy, but we also raise concerns about the safety of these agents, which have not been fully assessed. Although numerous randomized clinical trials of herbal medicines have been published and systematic reviews and meta-analyses of these studies are available, generalizations about the efficacy and safety of herbal medicines are clearly not possible. Recent publications have also highlighted the unintended consequences of herbal product use, including morbidity and mortality. It has been found that many phytochemicals have pharmacokinetic or pharmacodynamic interactions with drugs. The present review is limited to some herbal medicines that are native or cultivated in Mexico and that have significant use. We discuss the cultural uses, phytochemistry, pharmacological, and toxicological properties of the following plant species: nopal (Opuntia ficus), peppermint (Mentha piperita), chaparral (Larrea divaricata), dandlion (Taraxacum officinale), mullein (Verbascum densiflorum), chamomile (Matricaria recutita), nettle or stinging nettle (Urtica dioica), passionflower (Passiflora incarnata), linden flower (Tilia europea), and aloe (Aloe vera). We conclude that our knowledge of the therapeutic benefits and risks of some herbal medicines used in Mexico is still limited and efforts to elucidate them should be intensified.
Collapse
|
49
|
Wang G, Mao B, Xiong ZY, Fan T, Chen XD, Wang L, Liu GJ, Liu J, Guo J, Chang J, Wu TX, Li TQ. The quality of reporting of randomized controlled trials of traditional Chinese medicine: a survey of 13 randomly selected journals from mainland China. Clin Ther 2007; 29:1456-67. [PMID: 17825697 DOI: 10.1016/j.clinthera.2007.07.023] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2007] [Indexed: 02/05/2023]
Abstract
BACKGROUND The number of randomized controlled trials (RCTs) of traditional Chinese medicine (TCM) is increasing. However, there have been few systematic assessments of the quality of reporting of these trials. OBJECTIVE This study was undertaken to evaluate the quality of reporting of RCTs in TCM journals published in mainland China from 1999 to 2004. METHODS Thirteen TCM journals were randomly selected by stratified sampling of the approximately 100 TCM journals published in mainland China. All issues of the selected journals published from 1999 to 2004 were hand-searched according to guidelines from the Cochrane Centre. All reviewers underwent training in the evaluation of RCTs at the Chinese Centre of Evidence-based Medicine. A comprehensive quality assessment of each RCT was completed using a modified version of the Consolidated Standards of Reporting Trials (CONSORT) checklist (total of 30 items) and the Jadad scale. Disagreements were resolved by consensus. RESULTS Seven thousand four hundred twenty-two RCTs were identified. The proportion of published RCTs relative to all types of published clinical trials increased significantly over the period studied, from 18.6% in 1999 to 35.9% in 2004 (P < 0.001). The mean (SD) Jadad score was 1.03 (0.61) overall. One RCT had a Jadad score of 5 points; 14 had a score of 4 points; and 102 had a score of 3 points. The mean (SD) Jadad score was 0.85 (0.53) in 1999 (746 RCTs) and 1.20 (0.62) in 2004 (1634 RCTs). Across all trials, 39.4% of the items on the modified CONSORT checklist were reported, which was equivalent to 11.82 (5.78) of the 30 items. Some important methodologic components of RCTs were incompletely reported, such as sample-size calculation (reported in 1.1% of RCTs), randomization sequence (7.9%), allocation concealment (0.3 %), implementation of the random-allocation sequence (0%), and analysis of intention to treat (0%). CONCLUSION The findings of this study indicate that the quality of reporting of RCTs of TCM has improved, but remains poor.
Collapse
Affiliation(s)
- Gang Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Ckengdu, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Dube A, Manthata LN, Syce JA. The design and evaluation of placebo material for crude herbals: Artemisia afra herb as a model. Phytother Res 2007; 21:448-51. [PMID: 17262891 DOI: 10.1002/ptr.2084] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Herbal materials are known to present significant challenges with regard to designing credible placebos. This study intended to demonstrate the possibility of designing placebo material for crude herbals and used Artemisia afra, a popular traditional herbal medicine in South Africa, as a model. To produce the placebo, step-wise solvent extractions were conducted on the plant leaves and the process was monitored spectrophotometrically and using high performance liquid chromatography (HPLC) with diode array detection. The odour and taste between the placebo and A. afra was matched by inclusion of linalool and sodium saccharin, respectively. The muscle relaxant activity of the placebo was evaluated using an isolated guinea-pig tracheal muscle preparation. The UV absorbance of the extracts and the HPLC chromatograms, showed that most of the phytochemical constituents had been removed and the placebo closely resembled the A. afra leaves. The EC(50) of the placebo and the leaves were 4846.00 and 68.49 mg/mL, respectively, which showed that not only did the A. afra leaves possess muscle relaxant activity, but that the placebo did not possess any significant activity compared with the A. afra leaves (p value 0.0001). These results demonstrated that it is possible to design credible, pharmacologically inert placebo material for crude herbals.
Collapse
Affiliation(s)
- A Dube
- Discipline of Pharmacology, School of Pharmacy and the South African Herbal Science and Medicines Institute, University of the Western Cape, Bellville, South Africa
| | | | | |
Collapse
|