1
|
Wang XC, Liu XY, Shi KL, Meng QG, Yu YF, Wang SY, Wang J, Qu C, Lei C, Yu XP. Blinding assessment in clinical trials of traditional Chinese medicine: Exploratory principles and protocol. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:528-536. [PMID: 37957088 DOI: 10.1016/j.joim.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/11/2023] [Indexed: 11/15/2023]
Abstract
As one of the key components of clinical trials, blinding, if successfully implemented, can help to mitigate the risks of implementation bias and measurement bias, consequently improving the validity and reliability of the trial results. However, successful blinding in clinical trials of traditional Chinese medicine (TCM) is hard to achieve, and the evaluation of blinding success through blinding assessment lacks established guidelines. Taking into account the challenges associated with blinding in the TCM field, here we present a framework for assessing blinding. Further, this study proposes a blinding assessment protocol for TCM clinical trials, building upon the framework and the existing methods. An assessment report checklist and an approach for evaluating the assessment results are presented based on the proposed protocol. It is anticipated that these improvements to blinding assessment will generate greater awareness among researchers, facilitate the standardization of blinding, and augment the blinding effectiveness. The use of this blinding assessment may further advance the quality and precision of TCM clinical trials and improve the accuracy of the trial results. The blinding assessment protocol will undergo continued optimization and refinement, drawing upon expert consensus and experience derived from clinical trials. Please cite this article as: Wang XC, Liu XY, Shi KL, Meng QG, Yu YF, Wang SY, Wang J, Qu C, Lei C, Yu XP. Blinding assessment in clinical trials of traditional Chinese medicine: Exploratory principles and protocol. J Integr Med. 2023; 21(6): 528-536.
Collapse
Affiliation(s)
- Xiao-Cong Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiao-Yu Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Kang-le Shi
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Qing-Gang Meng
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Yue-Fan Yu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Shi-Yao Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Juan Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Chang Qu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Cong Lei
- School of Basic Medicine, Heilongjiang University of Chinese Medicine, Harbin 150040, Heilongjiang Province, China
| | - Xin-Ping Yu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| |
Collapse
|
2
|
Observational studies of traditional Chinese medicine may provide evidence nearly consistent with the randomized controlled trials: A meta-epidemiological study. Integr Med Res 2022; 11:100889. [DOI: 10.1016/j.imr.2022.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022] Open
|
3
|
Qiu L, Wu XW, Zhang SY, Yang M, Zhang SX, Fu JY, Li C, Zhang ZJ, Zheng PY, Lu ZH. Evaluation of efficacy and safety of Qiangzhu-qinggan formula as an adjunctive therapy in adult patients with severe influenza: study protocol for a randomized parallel placebo-controlled double-blind multicenter trial. Trials 2021; 22:955. [PMID: 34961550 PMCID: PMC8710932 DOI: 10.1186/s13063-021-05929-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/09/2021] [Indexed: 12/04/2022] Open
Abstract
Background Influenza can fall into three categories according to severity: mild influenza, severe influenza, and critical influenza. Severe influenza can result in critical illness and sometimes death particularly in patients with comorbidities, advanced age, or pregnancy. Neuraminidase inhibitors (NAIs) are the only antiviral drugs in widespread use for influenza. However, the effectiveness of NAIs against severe influenza is uncertain. New effective drugs or regimens are therefore urgently needed. Qiangzhu-qinggan (QZQG) formula has been found to be effective against influenza virus infection during long-term application in China, which lacks support of evidence-based clinical trial till now. This study is designed to assess the efficacy and safety of QZQG formula as an adjuvant therapy in adult patients with severe influenza. Methods This protocol is drawn up in accordance with the SPIRIT guidelines and CONSORT Extension for Chinese herbal medicine formulas. This is a randomized, placebo-controlled, double-blind, multicenter trial. Two hundred twenty-eight adults with severe influenza are randomly assigned in a 1:1 ratio to QZQG or placebo for 7 days. All participants need to receive 1 day of screening before randomization, 7 days of intervention, and 21 days of observation after randomization. The primary outcome is the proportion of clinical improvement, defined as the proportion of patients who met the criteria of 3 points or less in the seven-category ordinal scale or 2 points or less in National Early Warning Score 2 within 7 days after randomization. Discussion This is the first randomized, controlled, parallel, double-blind clinical trial to evaluate the efficacy and safety of traditional Chinese herbal formula granules as an adjuvant therapy in adult patients with severe influenza. This study aims to redefine the value of traditional Chinese herbal medicines in the treatment of virus-related respiratory infectious diseases and serves as an example of evidence-based clinical trials of other Chinese herbal medicines. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05929-8.
Collapse
Affiliation(s)
- Lei Qiu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Xian-Wei Wu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Shao-Yan Zhang
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Ming Yang
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Shun-Xian Zhang
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Ji-You Fu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Cui Li
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Zhi-Jie Zhang
- Department of Epidemiology, School of Public Health, Fudan University, 130 Dongan Road, No.8 building, Xuhui District, Shanghai, People's Republic of China
| | - Pei-Yong Zheng
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China.
| | - Zhen-Hui Lu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China.
| |
Collapse
|
4
|
She Y, Huang Q, Ye Z, Hu Y, Wu M, Qin K, Wei A, Yang X, Liu Y, Zhang C, Ye Q. The Therapeutic Principle of Combined Strengthening Qi and Eliminating Pathogens in Treating Middle-Advanced Primary Liver Cancer: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:714287. [PMID: 34776950 PMCID: PMC8578139 DOI: 10.3389/fphar.2021.714287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The combination of strengthening Qi and eliminating pathogens is an available therapeutic principle in traditional Chinese medicine (TCM) for primary liver cancer (PLC) at middle-advanced stage. However, there is a lack of reasonable evidence to support the proper application of this therapeutic principle. This meta-analysis aims to evaluate the efficacy and safety of Chinese medicinal formulas (CMFs), including two subgroup analyses of the principle of strengthening Qi and eliminating pathogens. Method: Clinical trials were obtained through searching of EMBASE, Web of Science, PubMed, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and two clinical trial registries. The randomized controlled trials with the combination of CMFs and transcatheter arterial chemoembolization (TACE) in the experiment group were acceptable, in contrast to the TACE alone in the control group. The statistics analysis was performed on Review Manager 5.4. Results: A total of eligible 24 trials were accessed in this work. Overall, CMFs could improve the survival duration of 6 months, 1 year, and 2 years, Karnofsky Performance Status, tumor objective response rate (ORR), AFP, and symptom. In the subgroup analysis, trials complying with the principle of single strengthening Qi did not show any significant difference in increasing tumor ORR. Meanwhile, the principle of combined strengthening Qi and eliminating pathogens was uncertain in improving symptoms and 1-year and 2-year survival time. In addition, the outcome indexes of ALT and AST were heterogeneous. In last, the total occurrence of adverse events could not be reduced via using CMFs. Patients treated with CMFs exhibited liver injury, fever, and white blood cell decline, with mild events occurring more frequently and severe events occurring less. Conclusion: CMFs are an effective treatment method to cure PLC at the middle-advanced stage. Adopting the principle of single strengthening Qi presents better efficacy in the long term by prolonging the survival duration. Following the principle of combined strengthening Qi and eliminating pathogens could be more beneficial to patients in short term by lessening the tumor size. CMFs have the advantage of reducing certain serious adverse events.
Collapse
Affiliation(s)
- Yingqi She
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinfeng Huang
- Department of Oncology, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Zhen Ye
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Hu
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingquan Wu
- Department of Pharmacy, Sichuan Provincial Orthopedic Hospital, Chengdu, China
| | - Kaihua Qin
- Health Preservation and Rehabilitation College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ailing Wei
- Department of Liver Disease, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Xin Yang
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuyao Liu
- Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Cuihan Zhang
- Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiaobo Ye
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
5
|
Koonrungsesomboon N, Morakote N, Karbwang J. Ethical considerations and challenges in herbal drug trials with the focus on scientific validity and risk assessment. Phytother Res 2021; 35:2396-2402. [PMID: 33222352 DOI: 10.1002/ptr.6962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/21/2020] [Accepted: 11/07/2020] [Indexed: 12/17/2022]
Abstract
Scientific validity and risk assessment are two main ethical issues which raise specific challenges and are unique to clinical trials investigating crude extracts/fractions from herbal materials. There are considerable challenges for both clinical investigators and ethics committee members in dealing with such issues, many of them remain unresolved, resulting in a large variation in ethical requirements, justification, and decisions. Despite a remarkable surge in herbal medicine research globally, a number of clinical investigators or even ethics committee members have limited confidence in dealing with related ethical issues. In this article, we extensively review and discuss the two main ethical issues (i.e., scientific validity and risk assessment) and highlight key considerations that are important for ethical review and justification for the conduct of herbal drug trials.
Collapse
Affiliation(s)
- Nut Koonrungsesomboon
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Nimit Morakote
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juntra Karbwang
- Department of Clinical Product Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
6
|
Wu M, Guo C, Guo N, Zhang T, Wang Y, Wang Y, Lin X, Wu F, Feng Y. Similarity Evaluation on the Compound TCM Formulation "Huoling Shengji Granule" and Its Placebo by Intelligent Sensory Evaluation Technologies and the Human Sensory Evaluation Method Based on Critical Quality Attributes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6637326. [PMID: 33936240 PMCID: PMC8062196 DOI: 10.1155/2021/6637326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022]
Abstract
To evaluate the similarity of Huoling Shengji granule (HLG) and its placebo at both granules and solution status, the innovative methods that consist of intelligent sensory evaluation technologies and human sensory evaluation methods were developed based on critical quality attributes (CQAs) of granule. The CQAs for traditional Chinese medicine (TCM) placebo granule were mainly divided into three categories: formulation attributes, visual attributes, and attributes of taste and smell. In this investigation, the novel intelligent sensory evaluation technologies including the physical property testing apparatus, computer vision system, color card, and electronic tongue (E-tongue) were employed for characterization of CQAs of HLG and its placebo. Meanwhile, human sensory evaluation by test panels was used to description the HLG and its placebo in terms of appearance, color, taste, and smell. On that basis, the similarity of placebo to CQAs of HLG was assessed by calculating the angle cosine values. The intelligent and human sensory evaluation results showed that the similarity values of HLG and its placebo about the CQAs at granule and solution status were all close to 1, which means that the two preparations have high similarities. In this study, the established similarity evaluation methods based on the CQAs were convenient and reliable, which can be utilized to evaluate the similarity of TCM granule and their placebo at granule and solution status, and demonstrated to be well applied in placebo-controlled trials.
Collapse
Affiliation(s)
- Mei Wu
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chengjie Guo
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ning Guo
- College of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tianyi Zhang
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Youjie Wang
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuan Wang
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao Lin
- College of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Wu
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- College of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Feng
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
7
|
Jieqin Z, Shuling L, Hairong C, Xingzhen D, Yanhong C, Zilin J, Bojun C. Efficacy and safety of Guhong injection for treating coronary microvascular disease: study protocol for a randomized controlled trial. Trials 2020; 21:75. [PMID: 31931853 PMCID: PMC6958693 DOI: 10.1186/s13063-019-3990-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/11/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronary microvascular disease (CMVD) can be described as one of the cardiovascular diseases with normal coronary angiography but evidence of myocardial ischemia or microcirculatory lesions, often presenting as angina pectoris attacks. Coronary artery microtubular dysfunction is one of the pathogenic features of coronary heart disease, but its occurrence and development and the current CMVD-intervention therapy needs further research. Chinese traditional medicine (TCM) has advantages for the treatment of cardiovascular diseases. Hence, this article describes an ongoing randomized controlled clinical trial based on the theory of TCM for the purpose of evaluating the efficacy and safety of Guhong injection versus placebo in patients with CMVD. METHODS/DESIGN This is a multicenter, randomized, parallel-arm, open-label, double-blind, placebo-controlled clinical trial. A total of 260 eligible patients will be allocated and randomly assigned, in a ratio of 1:1, to either the experimental group or the control group. The treatment course is 10 consecutive days, and with an 8-week follow-up. The primary outcome is therapeutic efficacy. Secondary outcomes include the quantitative score of TCM syndromes (a series of TCM symptoms and signs of coronary heart disease), the average frequency of anginal attacks, electrocardiogram (ECG) changes, inflammatory response, endothelial function indicators and myocardial metabolites. DISCUSSION This trial is strictly designed in accordance with principles and regulations issued by the China Food and Drug Administration (CFDA). The results should provide high-quality evidence on the efficacy and safety of Guhong injection in the treatment of CMVD. TRIAL REGISTRATION Chinese Clinical Trials Registry, ID: ChiCTR1900022902. Registered on 27 April 2019.
Collapse
Affiliation(s)
- Zhuang Jieqin
- The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510405, Guangdong Province, China
| | - Liu Shuling
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510006, Guangdong Province, China
| | - Cai Hairong
- The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510405, Guangdong Province, China
| | - Dai Xingzhen
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510006, Guangdong Province, China
| | - Chen Yanhong
- The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510405, Guangdong Province, China
| | - Jin Zilin
- The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510405, Guangdong Province, China
| | - Chen Bojun
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510006, Guangdong Province, China.
| |
Collapse
|
8
|
Zhang X, Tian R, Zhao C, Tang X, Lu A, Bian Z. Placebo design in WHO-registered trials of Chinese herbal medicine need improvements. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:299. [PMID: 31694626 PMCID: PMC6836479 DOI: 10.1186/s12906-019-2722-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 10/21/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Physical identical and pharmacological inert are the basic requirements for placebo design, which are essential in clinical trials to evaluate the efficacy of an intervention. However, it is difficult to makeup a placebo of Chinese herbal medicine (CHM) because of special color, taste and smell, etc. Currently, there is no specific requirements and standards for the creation of a CHM-placebo. The purpose of this study is to review the characteristics of the CHM-placebo design and application in registered clinical trials with CHM interventions and identify the common problems, if any. METHODS The World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) was systematically searched for CHM interventional trials with placebo-controlled design up to 31 December 2017. Registered information of each included trial was collected from specific registries involved in ICTRP through hyperlinks. Descriptive statistics were used to analyze the characteristics of placebo design in CHM trial registrations. RESULTS A total of 889 CHM interventional trials were registered from 1999 to 2017, and 40.8% (363) of them included CHM-placebo control design. The common ways of their design were: placebo as sole control (191, 52.6%); placebo as add-on control with baseline treatment (84, 23.1%); and placebo as double-dummy control (57, 15.7%). Among 363 included trials, 46 (12.7%) reported the compositions of placebos, including CHM ingredients (17 trials), excipients and other agents (29 trials). 2 (0.6%) reported pharmacological inert testing, and 52 (14.3%) descripted their placebos to be physically identical with the CHMs. 14 (3.9%) reported quality control of placebos, and 2 (0.6%) provided blinding assessment of placebos. CONCLUSIONS The placebos included in most CHM trial registrations is not optimal in terms of placebo design, application, evaluation and reporting. Specific guidelines or standards of CHM-placebo design, including usage requirements, preparation specifications, quality assessments and reporting guidelines should be developed thus to improve their quality.
Collapse
|
9
|
Chen M, Cui J, Zhang AL, Sze DMY, Xue CC, May BH. Adherence to CONSORT Items in Randomized Controlled Trials of Integrative Medicine for Colorectal Cancer Published in Chinese Journals. J Altern Complement Med 2017; 24:115-124. [PMID: 29068694 DOI: 10.1089/acm.2017.0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The majority of studies of integrative treatment for colorectal cancer (CRC) have been published in Chinese journals. These studies indicate potential benefits, but concerns have been raised over the quality of trials published in Chinese journals. The CONSORT statement provides a guide for study reporting that has been endorsed by more than 400 international journals. Previous studies have used the CONSORT checklist to assess the quality of randomized controlled trials (RCTs). OBJECTIVES This study focused on RCTs of integrative and traditional medicine for CRC published in Chinese journals and assessed: (1) the overall quality of reporting with a focus on methodological aspects; (2) change over time; and (3) the influence of study funding, level of institution conducting the trial, rank of the journal, and the length of the article. DESIGN Searches of seven databases identified RCTs. Quality was assessed using CONSORT 2010 with adaptations to facilitate scoring. Additional codes were added for publication year, hospital rank, report length, and status of the journal. Scores of each checklist item, total scores, and scores for eight items associated with RCT methodology were calculated. RESULTS Eighty-one studies were included in the main analyses. The RCT methodology subgroup scores were significantly higher in studies: with public funding, conducted by authors from university hospitals, published in higher ranked journals, and in longer articles. CONCLUSIONS Few Chinese journals mention CONSORT in their author guidelines. In these RCTs on CRC better reporting of RCT methodology was associated with ranking of the journal as "core," public funding of the RCT, and first or correspondent author from a university hospital but the quality of reporting had not significantly improved in 15 years. As the volume of scientific information produced in China grows, it is imperative that there is growth in the quality of this information.
Collapse
Affiliation(s)
- Menghua Chen
- 1 The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Bundoora, Victoria, Australia
| | - Jing Cui
- 1 The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Bundoora, Victoria, Australia
| | - Anthony L Zhang
- 1 The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Bundoora, Victoria, Australia
| | - Daniel Man-Yuen Sze
- 1 The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Bundoora, Victoria, Australia
| | - Charlie C Xue
- 1 The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Bundoora, Victoria, Australia .,2 Guangdong Provincial Academy of Chinese Medical Sciences , Guangzhou, China .,3 Guangdong Provincial Hospital of Chinese Medicine , Guangzhou, China
| | - Brian H May
- 1 The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Bundoora, Victoria, Australia
| |
Collapse
|
10
|
Cheng A, Xie Z. Challenges in orphan drug development and regulatory policy in China. Orphanet J Rare Dis 2017; 12:13. [PMID: 28100254 PMCID: PMC5241926 DOI: 10.1186/s13023-017-0568-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/07/2017] [Indexed: 01/15/2023] Open
Abstract
While regulatory policy is well defined for orphan drug development in the United States and Europe, rare disease policy in China is still evolving. Many Chinese patients currently pay out of pocket for international treatments that are not yet approved in China. The lack of a clear definition and therefore regulatory approval process for rare diseases has, until now, de-incentivized pharmaceutical companies to pursue rare disease drug development in China. In turn, many grassroots movements have begun to support rare disease patients and facilitate drug discovery through research. Recently, the Chinese FDA set new regulatory guidelines for drugs being developed in China, including an expedited review process for life-saving treatments. In this review, we discuss the effects of these new policy changes on and suggest potential solutions to innovate orphan drug development in China.
Collapse
Affiliation(s)
- Alice Cheng
- Rare Genomics Institute, 2657 Annapolis Road, Hanover, MD, 21076, USA.
| | - Zhi Xie
- Rare Genomics Institute, 2657 Annapolis Road, Hanover, MD, 21076, USA.,State Key Lab of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlienan Road, Guangzhou, 510040, Guangdong, China
| |
Collapse
|
11
|
Wang S, Jiang H, Yu Q, She B, Mao B. Efficacy and safety of Lian-Ju-Gan-Mao capsules for treating the common cold with wind-heat syndrome: study protocol for a randomized controlled trial. Trials 2017; 18:2. [PMID: 28057058 PMCID: PMC5217193 DOI: 10.1186/s13063-016-1747-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 12/09/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The common cold is a common and frequent respiratory disease mainly caused by viral infection of the upper respiratory tract. Chinese herbal medicine has been increasingly prescribed to treat the common cold; however, there is a lack of evidence to support the wide utility of this regimen. This protocol describes an ongoing phase II randomized controlled clinical trial, based on the theory of traditional Chinese medicine (TCM), with the objective of evaluating the efficacy and safety of Lian-Ju-Gan-Mao capsules (LJGMC), a Chinese patent medicine, compared with placebo in patients suffering from the common cold with wind-heat syndrome (CCWHS). METHODS/DESIGN This is a multicenter, randomized, double-blind, placebo-controlled phase II clinical trial. A total of 240 patients will be recruited and randomly assigned to a high-dose group, medium-dose group, low-dose group, and placebo-matched group in a 1:1:1:1 ratio. The treatment course is 3 consecutive days, with a 5-day follow-up. The primary outcome is time to all symptoms' clearance. Secondary outcomes include time to the disappearance of primary symptoms and each secondary symptom, time to fever relief, time to fever clearance, and change in TCM symptom and sign scores. DISCUSSION This trial is a well-designed study according to principles and regulations issued by the China Food and Drug Administration (CFDA). The results will provide high-quality evidence on the efficacy and safety of LJGMC in treating CCWHS and help to optimize the dose for the next phase III clinical trial. Moreover, the protocol presents a detailed and practical methodology for future clinical trials of drugs developed based on TCM. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IPR-15006504 . Registered on 4 June 2015.
Collapse
Affiliation(s)
- Shengjun Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hongli Jiang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Qin Yu
- National Clinical Trials Agency/GCP Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin She
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bing Mao
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
| |
Collapse
|
12
|
Yang B, Wang Z, Sheng C, Wang Y, Zhou J, Xiong XG, Peng W. Evidence-based review of oral traditional Chinese medicine compound recipe administration for treating weight drop-induced experimental traumatic brain injury. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:95. [PMID: 26956181 PMCID: PMC4784383 DOI: 10.1186/s12906-016-1076-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/03/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recently, a number of studies conducted and published in China have suggested that traditional Chinese medicine compound recipe (TCMCR) may be beneficial in the treatment of experimental traumatic brain injury (TBI). In this study, we conducted a systematic review and meta-analysis of the efficacy of TCMCR in TBI model with weight drop method to provide robust evidence on the effects of TCMCR and to determine whether TCMCR can be recommended for routine treatment or considered as a standard treatment for TBI. METHODS We identified eligible studies by searching five electronic databases on April 1, 2014, and pooled the data using the random-effects model. Results were reported in terms of standardized mean difference (SMD). We also calculated statistical heterogeneity, evaluated the studies' methodological quality and investigated the presence of publication bias. RESULTS Totally, 187 relevant publications were searched from databases, 25 of which met our inclusion criteria. The overall methodological quality of the most studies was poor, and there was evidence of statistical heterogeneity among studies along with small-study effects. Meta-analysis showed statistically significant effects indicating that TCMCR has a beneficial effect on TBI. CONCLUSIONS Despite the limitations, we concluded that TCMCR may reduce brain water content, improve BBB permeability, and decrease TNF-α/NO expression after experimental TBI in terms of overall efficacy. However, our review also indicates that more well-designed and well-reported animal studies are needed.
Collapse
|
13
|
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
|
14
|
Chung VCH, Wu X, Hui EP, Ziea ETC, Ng BFL, Ho RST, Tsoi KKF, Wong SYS, Wu JCY. Effectiveness of Chinese herbal medicine for cancer palliative care: overview of systematic reviews with meta-analyses. Sci Rep 2015; 5:18111. [PMID: 26669761 PMCID: PMC4680970 DOI: 10.1038/srep18111] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022] Open
Abstract
Chinese herbal medicines (CHM) are often used in managing cancer related symptoms but their effectiveness and safety is controversial. We conducted this overview of meta-analyses to summarize evidence on CHM for cancer palliative care. We included systematic reviews (SRs) with meta-analyses of CHM clinical trials on patients diagnosed with any type of cancer. Methodological quality of included meta-analyses was assessed with the Methodological Quality of Systematic Reviews (AMSTAR) Instrument. Fifty-one SRs with meta-analyses were included. They covered patients with lung (20 SRs), gastric (8 SRs), colorectal (6 SRs), liver (6 SRs), breast (2 SRs), cervical (1 SR), esophageal (1 SR), and nasopharyngeal (1 SR) cancers. Six SRs summarized evidence on various types of cancer. Methodological quality of included meta-analyses was not satisfactory. Overall, favorable therapeutic effects in improving quality of life among cancer patients have been reported. Conflicting evidence exists for the effectiveness of CHM in prolonging survival and in reducing chemotherapy and/or radiotherapy related toxicities. No serious adverse effects were reported in all included studies. Evidence indicated that CHM could be considered as an option for improving quality of life among patients receiving palliative care. It is unclear if CHM may increase survival, or reduce therapy related toxicities.
Collapse
Affiliation(s)
- Vincent CH Chung
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Xinyin Wu
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Edwin P. Hui
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Comprehensive Cancer Trials Unit, The Chinese University of Hong Kong, Hong Kong
| | - Eric TC Ziea
- Chinese Medicine Department, Hong Kong Hospital Authority, Hong Kong
| | - Bacon FL Ng
- Chinese Medicine Department, Hong Kong Hospital Authority, Hong Kong
| | - Robin ST Ho
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Kelvin KF Tsoi
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong
| | - Samuel YS Wong
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Justin CY Wu
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
15
|
Liu W, Jiang H, Zhang R, Jin F, Liu L, Long Y, Cui L, Li S, Zhong Y, Mao B. Efficacy and safety of Qing-Feng-Gan-Ke Granules in patients with postinfectious cough: study protocol of a novel-design phase III placebo-controlled, double-blind randomized trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:290. [PMID: 26286147 PMCID: PMC4545776 DOI: 10.1186/s12906-015-0812-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/10/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Postinfectious cough (PIC) is a common condition that affects millions of people worldwide every year. There is Western medicine for this condition but the treatment effect is often incomplete. Traditional Chinese medicine (TCM) has been increasingly prescribed for patients with PIC. Preliminary trials on Qing-Feng-Gan-Ke-Granules (QFGKG) conveyed promising results in treating PIC. This protocol describes an ongoing phase III randomized controlled clinical trial, designed according to a novel methodology of "one study, one primary outcome", with the objective of evaluating the efficacy and safety of QFGKG in patients suffering from PIC. METHODS/DESIGN This is a multicenter, phase III, randomized, double-blind, parallel-group, placebo-controlled clinical trial, comprising two simultaneously conducted study parts, part A and part B, intending to investigate two primary outcomes, i.e. time to cough resolution and cough symptom score, respectively. A total of 480 patients, aged 18 to 65 years, who complain of an ongoing persistent cough that has been lasting ≥ 3 weeks, will be recruited from six participating sites and then randomized to receive QFGKG 12.0 g twice daily or placebo 12.0 g twice daily. Each part will enroll 240 patients, with 180 patients being allocated to the QFGKG group and 60 to the placebo group. DISCUSSION Although traditional Chinese medicine is a structured intervention that has shown some promise in treating persistent cough, existing unconvincing evidence has noted limitations. This is a rare well-designed and rigorously-controlled, randomized, double-blind trial to evaluate the effects and safety of a Chinese herbal medicine in patients with postinfectious cough, providing tangible benefits for clinical research. Results of this trial are inclined to be conjectured as more truthful by implementing separate study parts that specifically estimate exclusive primary outcome. It will not only provide robust clinical evidence on the efficacy and safety of QFGKG for postinfectious cough, but will also provide a critical piece of information on the availability and superiority of a novel methodology for future clinical trials. The current trial is ongoing with recruitment of the predetermined number of patients being in progress. TRIAL REGISTRATION The two parts of this trial were separately registered with the Chinese Clinical Trial Registry: ChiCTR-TRC-13003278 (part A); and ChiCTR-TRC-13003337 (part B).
Collapse
Affiliation(s)
- Wei Liu
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China.
| | - Hongli Jiang
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China.
| | - Ruiming Zhang
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China.
| | - Faguang Jin
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital of The Fourth Military Medical University, 1 Xinsi Road, Xi'an, Shaanxi Province, 710038, China.
| | - Liangji Liu
- Department of Respiratory Medicine, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, 445 Bayi Avenue, Nanchang, Jiangxi Province, 330006, China.
| | - Youyu Long
- Department of Respiratory Medicine, The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, 816 Zhenli Street, Tianjin, 300150, China.
| | - Liying Cui
- Department of Respiratory Medicine, Affiliated Hospital of Inner Mongolia Medical University, 1 North Tongdao Street, Hohhot, Inner Mongolia, 010000, China.
| | - Suyun Li
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, 19 Renmin Road, Zhengzhou, Henan Province, 450000, China.
| | - Yunqing Zhong
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, 89-9 Dongge Road, Nanning, Guangxi Province, 530023, China.
| | - Bing Mao
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China.
| |
Collapse
|
16
|
Min J, Li XQ, She B, Chen Y, Mao B. Efficacy and safety of Gantong Granules in the treatment of common cold with wind-heat syndrome: study protocol for a randomized controlled trial. Trials 2015; 16:219. [PMID: 25986648 PMCID: PMC4488979 DOI: 10.1186/s13063-015-0735-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 04/29/2015] [Indexed: 02/05/2023] Open
Abstract
Background Although the common cold is generally mild and self-limiting, it is a leading cause of consultations with doctors and missed days from school and work. In light of its favorable effects of relieving symptoms and minimal side-effects, Traditional Chinese Medicine (TCM) has been widely used to treat the common cold. However, there is a lack of robust evidence to support the clinical utility of such a treatment. This study is designed to evaluate the efficacy and safety of Gantong Granules compared with placebo in patients with the common cold with wind-heat syndrome (CCWHS). Methods/Design This is a multicenter, phase IIb, double-blind, placebo-controlled and randomized clinical trial. A total of 240 patients will be recruited, from 5 centers across China and randomly assigned to the high-dose group, medium-dose group, low-dose group or placebo control group in a 1:1:1:1 ratio. All subjects will receive the treatment for 3 to 5 days, followed by a 7-day follow-up period. The primary outcome is the duration of all symptoms. Secondary outcomes include the duration of primary symptoms and each symptom, time to fever relief and time to fever clearance, change in TCM symptom score, and change in Symptom and Sign Score. Discussion This trial will provide high-quality evidence on the efficacy and safety of Gantong Granules in treating CCWHS, and help to optimize the dose selection for a phase III clinical trial. Trial registration The registration number is ChiCTR-TRC-14004255, which was assigned by the Chinese Clinical Trial Registry on 12 February 2014.
Collapse
Affiliation(s)
- Jie Min
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Xiao-qiang Li
- Anesthesia Department, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Bin She
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Yan Chen
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Bing Mao
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China.
| |
Collapse
|
17
|
Chung VCH, Ho RST, Wu X, Fung DHY, Lai X, Wu JCW, Wong SYS. Are meta-analyses of Chinese herbal medicine trials trustworthy and clinically applicable? A cross-sectional study. JOURNAL OF ETHNOPHARMACOLOGY 2015; 162:47-54. [PMID: 25554640 DOI: 10.1016/j.jep.2014.12.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Meta-analysis (MA) on Chinese herbal medicine (CHM) trials is increasingly published and indexed in major international databases but their trustworthiness and clinical applicability is uncertain. We aimed to assess the characteristics and methodological quality of MA on CHM. MATERIALS AND METHODS Cross-sectional study. MA published during 1993-2013 was sampled from MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effect. Bibliographical characteristics were abstracted and methodological quality was assessed using the validated AMSTAR tool by two independent reviewers. RESULTS Total of 201 MA were included and half were published in or after 2009. Only 7.5% being updates of previous reviews. Majority are published in journals with low or no impact factor, with a median of 1.5. These MA demonstrated methodological strengths in ensuring comprehensive literature search, providing characteristics of the included studies, assessing the scientific quality of included studies and appropriately using the scientific quality of included studies in formulating conclusions. Nevertheless, weaknesses in protocol provision, listing of included and excluded studies, inclusion of grey literature, use of appropriate meta-analytic technique as well as reporting of funding sources were prevalent. CHM and control interventions pooled in majority of MA are found to have substantial clinical heterogeneity in terms of composition, dosage form and route of administration. CONCLUSIONS There are rooms for improvement in methodological rigor, and in choosing clinically homogenous interventions and control for statistical pooling. These shortcomings limit the trustworthiness and clinical applicability of existing MA on CHM trials. To overcome the limitations of pair-wise meta-analysis in synthesizing trials comparing different CHM and control interventions, the potential of network meta-analysis should be explored.
Collapse
Affiliation(s)
- Vincent C H Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Robin S T Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Xinyin Wu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Daisy H Y Fung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Xin Lai
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Justin C W Wu
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
18
|
Shuliang Y, Yijia X, Guomin O. [Quality assessment of randomized controlled trials related to dental implant]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2014; 32:467-71. [PMID: 25490824 PMCID: PMC7041010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 05/05/2014] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To assess the quality of reporting by randomized controlled trial (RCT) related to dental implants in China during 2000 to 2012 by using the revised Jadad scale and consolidated standards of reporting trials (CONSORT) (2010) statement. METHODS The following electronic databases were searched: Chinese Biomedical Literature Database, Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, PubMed, and EMBASE. A total of 19 journals of stomatology in China were also searched manually. The qualities of RCT with dental implant published between 2000 and 2012 were assessed using CONSORT (2010) statement and revised Jadad scale. RESULTS Twenty-eight RCTs related to dental implants were identified. The quality of reporting in 28 articles was low. The mean revised Jadad score was 1.29 ± 0.71 and the CONSORT (2010) score was 9.75 ± 3.60. CONCLUSION The methodological qualities of the included studies on dental implants are generally low, and reporting quality remain unsatisfactory.
Collapse
|
19
|
Shuliang Y, Yijia X, Guomin O. [Quality assessment of randomized controlled trials related to dental implant]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2014; 32:467-471. [PMID: 25490824 PMCID: PMC7041010 DOI: 10.7518/hxkq.2014.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 05/05/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the quality of reporting by randomized controlled trial (RCT) related to dental implants in China during 2000 to 2012 by using the revised Jadad scale and consolidated standards of reporting trials (CONSORT) (2010) statement. METHODS The following electronic databases were searched: Chinese Biomedical Literature Database, Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, PubMed, and EMBASE. A total of 19 journals of stomatology in China were also searched manually. The qualities of RCT with dental implant published between 2000 and 2012 were assessed using CONSORT (2010) statement and revised Jadad scale. RESULTS Twenty-eight RCTs related to dental implants were identified. The quality of reporting in 28 articles was low. The mean revised Jadad score was 1.29 ± 0.71 and the CONSORT (2010) score was 9.75 ± 3.60. CONCLUSION The methodological qualities of the included studies on dental implants are generally low, and reporting quality remain unsatisfactory.
Collapse
|
20
|
Feng RZ, Lv JQ, Johnson AK, Montoya JD, Mao B. The efficacy and safety of Baoji Tablets for treating common cold with summer-heat and dampness syndrome: study protocol for a randomized controlled trial. Trials 2013; 14:440. [PMID: 24359521 PMCID: PMC3878040 DOI: 10.1186/1745-6215-14-440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 12/05/2013] [Indexed: 02/05/2023] Open
Abstract
Background Despite the high incidence and the economic impact of the common cold, there are still no effective therapeutic options available. Although traditional Chinese medicine (TCM) is widely used in China to treat the common cold, there is still a lack of high-quality clinical trials. This article sets forth the protocol for a high-quality trial of a new TCM drug, Baoji Tablets, which is designed to treat the common cold with summer-heat and dampness syndrome (CCSDS). The trial is evaluating both the efficacy and safety of Baoji Tablets. Methods/design This study is designed as a multicenter, phase II, parallel-group, double-blind, double-dummy, randomized and placebo-controlled trial. A total of 288 patients will be recruited from four centers. The new tablets group are administered Baoji Tablets 0.9 g and dummy Baoji Pills 3.7 g. The old pills group are administered dummy Baoji Tablets 0.9 g and Baoji Pills 3.7 g. The placebo control group are administered dummy Baoji Tablets 0.9 g and dummy Baoji Pills 3.7 g. All drugs are taken three times daily for 3 days. The primary outcome is the duration of all symptoms. Secondary outcomes include the duration of primary and secondary symptoms, changes in primary and secondary symptom scores and cumulative symptom score at day 4, as well as an evaluation of treatment efficacy. Discussion This is the first multicenter, double-blind, double-dummy, randomized and placebo-controlled trial designated to treat CCSDS in an adult population from China. It will establish the basis for a scientific and objective assessment of the efficacy and safety of Baoji Tablets for treating CCSDS, and provide evidence for a phase III clinical trial. Trial registration This study is registered with the Chinese Clinical Trial Registry. The registration number is ChiCTR-TRC-13003197.
Collapse
Affiliation(s)
| | | | | | | | - Bing Mao
- Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China.
| |
Collapse
|
21
|
Chinese herbal medicine for postinfectious cough: a systematic review of randomized controlled trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:906765. [PMID: 24348727 PMCID: PMC3853348 DOI: 10.1155/2013/906765] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/26/2013] [Accepted: 09/26/2013] [Indexed: 02/05/2023]
Abstract
Chinese herbal medicine has been commonly used in the treatment of postinfectious cough. The aim of this review is to systematically evaluate the efficacy and safety of Chinese herbal medicine for postinfectious cough. An extensive search for RCTs was performed using multiple electronic databases, supplemented with a manual search. All studies included were confirmed with specific inclusion criteria. Methodological quality of each study was examined according to the Cochrane risk of bias assessment. Quality of evidence was evaluated using rating approach developed by GRADE working group. The literature search yielded 352 results, of which 12 RCTs satisfied the inclusion criteria, offering moderate-to-high levels of evidence. Methodological quality was considered high in three trials, while in the other nine studies the unclear risk of bias was in the majority. Findings suggested that, compared with western conventional medicine or placebo, Chinese herbal medicine could effectively improve core symptoms of postinfectious cough, act better and have earlier antitussive effect, and enhance patients' quality of life. No serious adverse event was reported.
Collapse
|
22
|
Turner L, Shamseer L, Altman DG, Weeks L, Peters J, Kober T, Dias S, Schulz KF, Plint AC, Moher D. Consolidated standards of reporting trials (CONSORT) and the completeness of reporting of randomised controlled trials (RCTs) published in medical journals. Cochrane Database Syst Rev 2012; 11:MR000030. [PMID: 23152285 PMCID: PMC7386818 DOI: 10.1002/14651858.mr000030.pub2] [Citation(s) in RCA: 305] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND An overwhelming body of evidence stating that the completeness of reporting of randomised controlled trials (RCTs) is not optimal has accrued over time. In the mid-1990s, in response to these concerns, an international group of clinical trialists, statisticians, epidemiologists, and biomedical journal editors developed the CONsolidated Standards Of Reporting Trials (CONSORT) Statement. The CONSORT Statement, most recently updated in March 2010, is an evidence-based minimum set of recommendations including a checklist and flow diagram for reporting RCTs and is intended to facilitate the complete and transparent reporting of trials and aid their critical appraisal and interpretation. In 2006, a systematic review of eight studies evaluating the "effectiveness of CONSORT in improving reporting quality in journals" was published. OBJECTIVES To update the earlier systematic review assessing whether journal endorsement of the 1996 and 2001 CONSORT checklists influences the completeness of reporting of RCTs published in medical journals. SEARCH METHODS We conducted electronic searches, known item searching, and reference list scans to identify reports of evaluations assessing the completeness of reporting of RCTs. The electronic search strategy was developed in MEDLINE and tailored to EMBASE. We searched the Cochrane Methodology Register and the Cochrane Database of Systematic Reviews using the Wiley interface. We searched the Science Citation Index, Social Science Citation Index, and Arts and Humanities Citation Index through the ISI Web of Knowledge interface. We conducted all searches to identify reports published between January 2005 and March 2010, inclusive. SELECTION CRITERIA In addition to studies identified in the original systematic review on this topic, comparative studies evaluating the completeness of reporting of RCTs in any of the following comparison groups were eligible for inclusion in this review: 1) Completeness of reporting of RCTs published in journals that have and have not endorsed the CONSORT Statement; 2) Completeness of reporting of RCTs published in CONSORT-endorsing journals before and after endorsement; or 3) Completeness of reporting of RCTs before and after the publication of the CONSORT Statement (1996 or 2001). We used a broad definition of CONSORT endorsement that includes any of the following: (a) requirement or recommendation in journal's 'Instructions to Authors' to follow CONSORT guidelines; (b) journal editorial statement endorsing the CONSORT Statement; or (c) editorial requirement for authors to submit a CONSORT checklist and/or flow diagram with their manuscript. We contacted authors of evaluations reporting data that could be included in any comparison group(s), but not presented as such in the published report and asked them to provide additional data in order to determine eligibility of their evaluation. Evaluations were not excluded due to language of publication or validity assessment. DATA COLLECTION AND ANALYSIS We completed screening and data extraction using standardised electronic forms, where conflicts, reasons for exclusion, and level of agreement were all automatically and centrally managed in web-based management software, DistillerSR(®). One of two authors extracted general characteristics of included evaluations and all data were verified by a second author. Data describing completeness of reporting were extracted by one author using a pre-specified form; a 10% random sample of evaluations was verified by a second author. Any discrepancies were discussed by both authors; we made no modifications to the extracted data. Validity assessments of included evaluations were conducted by one author and independently verified by one of three authors. We resolved all conflicts by consensus.For each comparison we collected data on 27 outcomes: 22 items of the CONSORT 2001 checklist, plus four items relating to the reporting of blinding, and one item of aggregate CONSORT scores. Where reported, we extracted and qualitatively synthesised data on the methodological quality of RCTs, by scale or score. MAIN RESULTS Fifty-three publications reporting 50 evaluations were included. The total number of RCTs assessed within evaluations was 16,604 (median per evaluation 123 (interquartile range (IQR) 77 to 226) published in a median of six (IQR 3 to 26) journals. Characteristics of the included RCT populations were variable, resulting in heterogeneity between included evaluations. Validity assessments of included studies resulted in largely unclear judgements. The included evaluations are not RCTs and less than 8% (4/53) of the evaluations reported adjusting for potential confounding factors. Twenty-five of 27 outcomes assessing completeness of reporting in RCTs appeared to favour CONSORT-endorsing journals over non-endorsers, of which five were statistically significant. 'Allocation concealment' resulted in the largest effect, with risk ratio (RR) 1.81 (99% confidence interval (CI) 1.25 to 2.61), suggesting that 81% more RCTs published in CONSORT-endorsing journals adequately describe allocation concealment compared to those published in non-endorsing journals. Allocation concealment was reported adequately in 45% (393/876) of RCTs in CONSORT-endorsing journals and in 22% (329/1520) of RCTs in non-endorsing journals. Other outcomes with results that were significant include: scientific rationale and background in the 'Introduction' (RR 1.07, 99% CI 1.01 to 1.14); 'sample size' (RR 1.61, 99% CI 1.13 to 2.29); method used for 'sequence generation' (RR 1.59, 99% CI 1.38 to 1.84); and an aggregate score over reported CONSORT items, 'total sum score' (standardised mean difference (SMD) 0.68 (99% CI 0.38 to 0.98)). AUTHORS' CONCLUSIONS Evidence has accumulated to suggest that the reporting of RCTs remains sub-optimal. This review updates a previous systematic review of eight evaluations. The findings of this review are similar to those from the original review and demonstrate that, despite the general inadequacies of reporting of RCTs, journal endorsement of the CONSORT Statement may beneficially influence the completeness of reporting of trials published in medical journals. Future prospective studies are needed to explore the influence of the CONSORT Statement dependent on the extent of editorial policies to ensure adherence to CONSORT guidance.
Collapse
Affiliation(s)
- Lucy Turner
- Ottawa Hospital Research Institute, Ottawa, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Jia Y, Zhang S, Huang F, Leung SW. Could ginseng-based medicines be better than nitrates in treating ischemic heart disease? A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2012; 20:155-66. [DOI: 10.1016/j.ctim.2011.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 12/07/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022] Open
|
24
|
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]
|
25
|
Fu JY, Zhang X, Zhao YH, Chen DZ, Huang MH. Global performance of traditional Chinese medicine over three decades. Scientometrics 2011. [DOI: 10.1007/s11192-011-0521-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|