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Cui HJ, Wu YF. The Effects of Different Dosages on Micronized Purified Flavonoid Fraction's Treatment of Lower Limb Chronic Venous Disease: A Meta-Analysis. J Endovasc Ther 2024:15266028241262700. [PMID: 39066519 DOI: 10.1177/15266028241262700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Micronized purified flavonoid fraction (MPFF) is a widely prescribed and extensively investigated venoactive drug (VAD). The standard dosage for MPFF is 500 mg administered twice daily. However, a new daily dose of 1000 mg has just been introduced. OBJECTIVE This study investigated whether a daily dose of 1000 mg MPFF could be implemented and embraced by the public and still has the same therapeutic effects as conventional pharmaceuticals. METHODS For this meta-analysis, we searched MEDLINE, Embase, Science of Web, Cochrane, and PubMed databases and forward and backward citations for studies published between database inception and March 2023. Three randomized controlled trials (RCTs) of comparison of different dosages of MPFF to evaluate whether there is a significant difference between them were included, without language or date restrictions. Due to the small sample size of the study included, we conducted a simple sensitivity test using a one-by-one exclusion method, and the results showed that the study did not affect the final consolidation conclusion. The quality of the evidence was assessed using the Cochrane risk-of-bias tool. RESULTS Out of 232 studies, 99 were eligible and 39 RCTs had data, all with low to moderate bias. Overall, 1924 patients (experimental group: 967, control group: 957) in 3 RCTs met the criteria. There is no significant difference in patient compliance, efficacy, clinical adverse events, and quality of life scores between MPFF 1000 mg once daily and MPFF 500 mg twice daily (standardized mean difference [SMD]: 0.049 [0.048, 0.145], p=0.321, risk ratio [RR]: 0.981 [0.855, 1.125], p=0.904, and SMD: 0.063 [0.034, 0.160], p=0.203). INTERPRETATION In symptomatic chronic venous disease patients, MPFF 1000 mg once daily and MPFF 500 mg twice daily improve patient compliance, lower limb discomfort, clinical adverse events, and quality of life scores similarly. Regular medical care should recommend MPFF 1000 mg daily more often. CLINICAL IMPACT Micronized purified flavonoid fraction (MPFF) is a popular venoactive medication (VAD) in modern medicine.MPFF is effective in treating lower extremity venous problems.Currently, besides conventional 500 mg tablets, there exist alternative dosage forms such as solutions, chewable tablets, and other novel formulations for MPFF.The excessive frequency and amount of medication may have a negative impact on patient adherence.
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Affiliation(s)
- Hong-Jie Cui
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying-Feng Wu
- Department of Vascular Surgery, Luhe Hospital, Capital Medical University, Beijing, China
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Kwiatkowska A, Borejsza-Wysocki M, Głyda M, Pietrzak AM, Szczepkowski M, Organ A, Banasiewicz T. The influence of supportive therapy with a six-component myophlebotropic preparation on the reduction of symptoms in patients with symptoms of hemorrhoidal disease. POLISH JOURNAL OF SURGERY 2024; 96:1-8. [PMID: 38940246 DOI: 10.5604/01.3001.0054.6443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
<b>Introduction:</b> Hemorrhoidal disease is the most common disease treated in proctology ambulatories. Conservative treatment is the basic form of treatment for this disease. One of the elements of treatment may be preparations with myoand phlebotropic effects.<b>Aim:</b> To assess the effect of a multi-ingredient myophlebotropic dietary supplement used as an adjunct on the rate and effectiveness of symptom relief in patients with stage II and III hemorrhoidal disease.<b>Material and method:</b> Patients with stage II and III hemorrhoidal disease with clinical symptoms such as pain, burning, itching and bleeding were qualified for the study. The patients were divided into two groups. The control group (Group I) of 29 patients receiving standard local treatment plus placebo and the study group (Group II) of 32 patients receiving the same local treatment and a six-component myophlebotropic product. Symptoms were analyzed at the time of inclusion in the study (day 0), after 4 and 10 days of therapy. The severity of hemorrhoidal disease and the feeling of relief were assessed on the day of inclusion (W0) and after 30 days of therapy.<b>Results:</b> There were no statistical differences between the groups in terms of disease advancement, age, gender, and duration of symptoms. Compared to the moment of inclusion in the study (W0), after 4 days (W1), after 10 days (W2) of taking the multi- -component product, there was a statistically significant improvement in the VAS scale: spontaneous pain and pain during defecation. In the qualitative assessment (yes/no), there were statistically significantly fewer cases of burning in the anus and itching. The treatment did not affect the rate of spontaneous bleeding, which was low at the beginning of the study, but significantly reduced the rate of bleeding during defecation. After 30 days of observation, it was found that the improvement in the severity of hemorrhoidal disease symptoms was significantly higher in the group using the tested preparation. Relief after a month of the study (one-question method) was noted in the group of patients receiving the tested product.<b>Conclusions:</b> The tested six-component myophlebotropic product proved to be effective in reducing the severity of symptoms such as spontaneous pain, pain during defecation, burning/burning in the anus and bleeding during defecation. Statistical significance was demonstrated in the symptom's relief and reduction in the severity of hemorrhoidal disease.
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Affiliation(s)
- Anna Kwiatkowska
- Department of Clinical General Surgery, Endocrine Surgery, and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Maciej Borejsza-Wysocki
- Department of Clinical General Surgery, Endocrine Surgery, and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Michał Głyda
- Department of Clinical General Surgery, Endocrine Surgery, and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Anna Maria Pietrzak
- 2nd Department of Gastroenterology, Centre of Postgraduate Medical Education, Warsaw, Poland, Department of Gastroenterology, Bielanski Hospital, Warsaw, Poland
| | - Marek Szczepkowski
- Department of Colorectal, General and Oncological Surgery, Medical Centre of Postgraduate Education in Warsaw, Bielański Hospital in Warsaw
| | - Andrzej Organ
- Department of General and Oncological Surgery, St. Padre Pio Provincial Hospital in Przemysl, Poland
| | - Tomasz Banasiewicz
- Department of Clinical General Surgery, Endocrine Surgery, and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
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Medkova YS, Tulina I, Yudina V, Abdullaev R, Shcherbakova V, Novikov I, Nikonov A, Tsarkov P. Efficacy of Micronized Purified Flavonoid Fraction in the Posthemorrhoidectomy Period Trial: Open-Label Randomized Controlled Trial. Dis Colon Rectum 2024; 67:826-833. [PMID: 38380823 DOI: 10.1097/dcr.0000000000003211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Frequent early postoperative complications of hemorrhoidectomy are thrombosis and edema of mucocutaneous "bridges." OBJECTIVE This study aimed to investigate the efficacy of micronized purified flavonoid fraction in preventing complications after elective hemorrhoidectomy. DESIGN Prospective unicentral open-label randomized controlled trial. SETTINGS 2021-2022 at the Clinic of Colorectal and Minimally Invasive Surgery at Sechenov University (Moscow, Russia). PATIENTS Patients who underwent hemorrhoidectomy for grade III and IV hemorrhoids. INTERVENTIONS After hemorrhoidectomy, patients were randomly assigned either to standard treatment (peroral nonsteroid anti-inflammatory drugs and local anesthetics, topical steroids, psyllium, warm sitz baths, and nifedipine gel), referred to as the control group, or to standard treatment with micronized purified flavonoid fraction, referred to as the study group, and followed up for 60 days. MAIN OUTCOME MEASURES Thrombosis or edema of mucocutaneous bridges and pain intensity on a visual analog scale оn postoperative days 1-7, 14, 21, and 30; quality of life and patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30; and perianal skin tags оn postoperative day 60. RESULTS The data from 50 patients were analyzed (25 in each group). The visual analog scale demonstrated no differences between groups in each follow-up point. Compared to the control group, the patients in the study group had a significantly higher patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30 and a significantly lower rate of thrombosis or edema of mucocutaneous bridges оn postoperative days 1-7 and 14. Patients in the study group had significantly lower rates of perianal skin tags. LIMITATIONS Unicenter open-label design. CONCLUSIONS Micronized purified flavonoid fraction in the posthemorrhoidectomy period is an effective adjunct to standard treatment that helps reduce the rate of thrombosis and edema of mucocutaneous bridges, improves patient-assessed treatment effect, and prevents postoperative perianal skin tags formation. Micronized purified flavonoid fraction in the posthemorrhoidectomy period is not associated with additional pain relief in comparison with nonmicronized purified flavonoid fraction standard treatment. See Video Abstract . EFICACIA DE LA FRACCIN DE FLAVONOIDES PURIFICADA MICRONIZADA EN EL PERODO POSTERIOR A LA HEMORROIDECTOMA ENSAYO MOST ENSAYO CONTROLADO, ALEATORIZADO, ABIERTO ANTECEDENTES:Una complicación postoperatoria temprana frecuente de la hemorroidectomía es la trombosis y el edema de los "puentes" mucocutáneos.OBJETIVO:Investigamos la eficacia de la fracción de flavonoides purificada micronizada en la prevención de complicaciones después de una hemorroidectomía electiva.DISEÑO:Ensayo controlado aleatorio, prospectivo, unicentral, abierto.AJUSTES:2021-2022 Clínica de Cirugía Colorrectal y Mínimamente Invasiva Universidad Sechenov (Moscú, Rusia).PACIENTES:Pacientes después de hemorroidectomía, que se realizó para hemorroides de grado III-IV.INTERVENCIONES:Después de la hemorroidectomía, los pacientes fueron asignados aleatoriamente al tratamiento estándar (antiinflamatorios no esteroides perorales y anestésicos locales, esteroides tópicos, psyllium, baños de asiento tibios, gel de nifedipina) - grupo de control, o al tratamiento estándar con flavonoide purificado micronizado. fracción (grupo de estudio) y seguido durante 60 días.RESULTADOS DE MEDIDAS PRINCIPALES:Trombosis o edema de puentes mucocutáneos e intensidad del dolor en una escala analógica visual entre el 1.º, 7.º, 14.º, 21.º y 30.º día postoperatorio; calidad de vida y efecto del tratamiento evaluado por el paciente el día 1, 3, 7, 21 y 30 del postoperatorio; Marcas cutáneas perianales en el día 60 del postoperatorio.RESULTADOS:Se analizaron los datos de 50 pacientes (25 en cada grupo). La escala analógica visual no demostró diferencias entre grupos en cada punto de seguimiento. En comparación con el grupo de control, los pacientes en el grupo de estudio tuvieron un efecto del tratamiento evaluado por el paciente significativamente mayor en los días 1, 3, 7, 21 y 30 después de la operación, una tasa significativamente menor de trombosis o edema de los puentes mucocutáneos en los días 1, 7 y 14.. Los pacientes del grupo de estudio tuvieron tasas significativamente más bajas de marcas en la piel perianal.LIMITACIONES:Diseño Unicenter de etiqueta abierta.CONCLUSIONES:La fracción de flavonoides purificada micronizada en el período posterior a la hemorroidectomía es un complemento eficaz del tratamiento estándar que ayuda a reducir la tasa de trombosis y edema de los puentes mucocutáneos, mejora el efecto del tratamiento evaluado por el paciente y previene la formación de marcas cutáneas perianales posoperatorias. La fracción de flavonoides purificados micronizados en el período posterior a la hemorroidectomía no se asocia con un alivio adicional del dolor en comparación con el tratamiento estándar con la fracción de flavonoides purificados no micronizados. (Traducción-Yesenia Rojas-Khalil ).
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Affiliation(s)
- Yuliya Sergeevna Medkova
- Department of Colorectal Surgery, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Inna Tulina
- Department of Colorectal Surgery, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Valeriya Yudina
- Department of Colorectal Surgery, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ruslan Abdullaev
- Department of Colorectal Surgery, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vlada Shcherbakova
- Department of Colorectal Surgery, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ivan Novikov
- Department of Heart Rhythm Disorders, Federal State Budget Organization, National Medical Research Center of Cardiology, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Andrey Nikonov
- Department of Obstetrics and Gynecology, Snegirev Clinic of Obstetrics and Gynecology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Petr Tsarkov
- Department of Colorectal Surgery, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
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Dormer L. Journal of Comparative Effectiveness Research: 2022 year in review. J Comp Eff Res 2023; 12:e230026. [PMID: 36916995 PMCID: PMC10402760 DOI: 10.57264/cer-2023-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/15/2023] Open
Affiliation(s)
- Laura Dormer
- Editor – Journal of Comparative Effectiveness Research, Becaris Publishing Ltd, Royston, SG8 5AB, UK
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Lohsiriwat V, Sheikh P, Bandolon R, Ren DL, Roslani AC, Schaible K, Freitag A, Martin M, Yaltirik P, Godeberge P. Recurrence Rates and Pharmacological Treatment for Hemorrhoidal Disease: A Systematic Review. Adv Ther 2023; 40:117-132. [PMID: 36331754 PMCID: PMC9859842 DOI: 10.1007/s12325-022-02351-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Hemorrhoidal disease (HD) is characterized by prolapse of the inflamed and bleeding vascular tissues of the anal canal. Although HD is associated with a high recurrence rate, there is a lack of understanding around interventions that can reduce recurrence and improve outcomes for patients. As such, a systematic literature review (SLR) was conducted to summarize evidence on epidemiology, recurrence, and efficacy of interventions in HD. METHODS Real-world evidence (RWE) studies evaluating the incidence, prevalence, or recurrence of HD, as well as SLRs including a meta-analytic component reporting on the efficacy of systemic or topical pharmacological treatments for adults with HD, were included. Systematic searches were conducted in MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews. RESULTS The SLR identified 44 eligible publications. Consistent data were limited on the epidemiology of HD or HD recurrence. Specifically, incidence and prevalence reported across geographies were impacted by differences in data collection. Reported risk factors for HD were sedentary behavior, constipation, male gender, and age. Twenty-three RWE studies and one meta-analysis reported HD recurrence rates ranging from 0 to 56.5% following surgery or phlebotonics, with most (n = 19) reporting rates of 20% or less. In addition to time since treatment, risk factors for recurring disease were similar to those for HD in general. With respect to treatment, micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments. CONCLUSION The SLRs did not identify any RWE studies reporting recurrence in patients receiving systemic or topical treatments, highlighting the need for future research in this area. Further, more studies are needed to understand the optimum duration of medical treatment to prevent recurrence.
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Affiliation(s)
- Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
| | - Parvez Sheikh
- Department of Colorectal Surgery, Saifee Hospital, Mumbai, India
| | | | - Dong-Lin Ren
- Department of Colorectal Surgery, The Sixth Affiliated Hospital (Gastrointestinal and Anal Hospital), Sun Yat-Sen University, Guangzhou, China
| | - April Camilla Roslani
- Department of Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | | | | | | | - Pelin Yaltirik
- Internal Medicine and Neuropsychiatry, Global Medical and Patient Affairs (GMPA), Servier, Suresnes, France
| | - Philippe Godeberge
- Unité d'endoscopie et de proctologie, Clinique du Trocadéro, Paris, France
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Sturiale A, Fralleone L, Cafaro D, Gallo G, Brusciano L, Celedon Porzio F, Venkataratnaiah Setty S, Naldini G. Safety and efficacy of topical drug-free cream in subjects with hemorrhoidal disease: a randomized, double blind, clinical trial. Minerva Gastroenterol (Torino) 2022; 68:407-414. [PMID: 35511655 DOI: 10.23736/s2724-5985.22.03173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hemorrhoidal disease (HD) is one of the most common anorectal benign disorder affecting millions of people around the world. Grade I-II HD are generally treated with a conservative approach with topical products such as creams and ointments considered a safe and effective option to treat mild symptoms. The aim of the present study was to assess the safety and efficacy of a topical medical device (Lenoid™; International Health Science [IHS] - Biofarma Group, Mereto di Tomba, Udine, Italy) in patients affected by symptomatic HD. METHODS This study is a randomized, double blind, placebo-controlled, 2-weeks clinical trial. Patients affected by I-II grade symptomatic HD were enrolled in the study and then randomly assigned to Lenoid™ arm (LA) or placebo arm (PA), respectively. Patients were evaluated before and after intervention through clinical examination and disease-specific questionnaires assessing symptoms such as pain, tenesmus, pruritus and anal discharge. RESULTS A total of 68 patients were screened and 60 (30 in each group) were enrolled into the study. All patients belonging to LA showed a statistically significant improvement of each symptom after 7 and 14 days of treatment when compared to PA (P<0.001). Furthermore, subjective improvement of change in overall assessment of disease was observed in the LA but not in the PA. No serious adverse events were recorded. CONCLUSIONS The tested product was found safe and effective in improving clinical signs and symptoms in patients with grade I-II HD.
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Affiliation(s)
- Alessandro Sturiale
- Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy -
| | - Lisa Fralleone
- Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy
| | - Danilo Cafaro
- Unit of Proctology Surgery, Tropea Hospital, Vibo Valentia, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, The Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Luigi Brusciano
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Felipe Celedon Porzio
- Unit of Coloproctological Surgery, Hospital de la Fuerza Aerea de Chile, Santiago de Chile, Chile
| | | | - Gabriele Naldini
- Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy
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Bogachev V, Boldin B, Turkin P, Samenkov A, Dzhenina O. Micronized purified flavonoid fraction-based conservative treatment of chronic venous disease in a real-world setting. Future Cardiol 2022; 18:777-785. [PMID: 36004765 DOI: 10.2217/fca-2022-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aims: To investigate the effectiveness and tolerability of adjunctive micronized purified flavonoid fraction (MPFF) in patients with chronic venous disease (CVD). Patients & methods: This observational study included adults (≥18 years) with clinical-etiology-anatomy-pathophysiology (CEAP) class C4 CVD for whom MPFF was indicated. Outcomes included changes in subcutaneous adipose thickness, venous clinical severity score, CVD symptoms (using a visual analogue scale) and tolerability. Results: Of 381 patients, 365 completed the study. After 6 months, subcutaneous adipose tissue thickness, venous clinical severity score and visual analogue scale scores significantly improved (all p < 0.001 vs baseline). No adverse drug reactions occurred. Conclusion: Adjunctive MPFF treatment improves skin and subcutaneous tissue conditions in CVD patients. Clinical Trial Registration: NCT04138576 (ClinicalTrials.gov).
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Affiliation(s)
- Vadim Bogachev
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Boris Boldin
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Pavel Turkin
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Alexander Samenkov
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Olga Dzhenina
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Fu H, Guo W, Zhou B, Liu Y, Gao Y, Li M. Efficacy and safety of micronized purified flavonoid fractions for the treatment of postoperative hemorrhoid complications: A systematic review and meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 104:154244. [PMID: 35752073 DOI: 10.1016/j.phymed.2022.154244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/20/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hemorrhoids, a common anorectal disease, seriously affects patients' quality of life. Micronized purified flavonoid fractions (MPFF) have been shown to improve hemorrhoid symptoms. PURPOSE To evaluate the efficacy and safety of MPFF in treating postoperative hemorrhoid complications. STUDY DESIGN A systematic review and meta-analysis of existing literature on natural compounds for treating postoperative complications of hemorrhoids. METHODS A literature search was conducted using five databases, namely PubMed, WanFang, CNKI, Embase, and the Cochrane Library, to identify randomized controlled trials (RCTs) on the effects of MPFF treatment on hemorrhoids. Stata 15.1 and Revman 15.4 were used to assess the data, while subgroup and sensitivity analyses were performed to evaluate potential heterogeneity, and trial sequential analysis (TSA) and Egger test were used to evaluate the reliability of each trial. RESULTS A total of 22 RCTs, including 2,335 participants were included in the analysis. MPFF improved the clinical efficacy of post-hemorrhoidectomy and reduced the bleeding rate, pain score, and edema score, although no substantial effect on adverse reactions was reported. Subgroup analyses showed a significant reduction in pain score and bleeding rate in trials with duration of 4-10 days and an improvement in clinical efficacy. Treatment for ≥ 10 days significantly improved the edema score; a dosage range of 1,800-2,700 mg/day of MPFF significantly reduced edema and pain scores, whereas < 1,800 mg/day significantly improved clinical efficacy. CONCLUSIONS Based on searching the relevant literatures, this is the first meta-analysis on MPFF treatment of postoperative hemorrhoid complications. Our findings, validated by TSA, suggest that MPFF is safe and effective in reducing postoperative hemorrhoid complications, and that dose and duration are key factors in its efficacy, as illustrated by subgroup analysis. However, due to the small sample size, the standardized treatment regimen of MPFF could not be obtained; therefore, further research is warranted.
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Affiliation(s)
- Haiqi Fu
- Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110
| | - Wenfang Guo
- Inner Mongolia Institute of Traditional Chinese and Mongolian Medicine, Hohhot, Inner Mongolia 010010
| | - Baochang Zhou
- Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110
| | - Yibo Liu
- Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110
| | - Yuan Gao
- Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110; Inner Mongolia Hospital of Traditional Chinese Medicine, Hohhot, Inner Mongolia 010020.
| | - Minhui Li
- Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110; Inner Mongolia Hospital of Traditional Chinese Medicine, Hohhot, Inner Mongolia 010020; Inner Mongolia Institute of Traditional Chinese and Mongolian Medicine, Hohhot, Inner Mongolia 010010; Baotou Medical College, Baotou, Inner Mongolia 014040.
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Gravina AG, Pellegrino R, Facchiano A, Palladino G, Loguercio C, Federico A. Evaluation of the Efficacy and Safety of a Compound of Micronized Flavonoids in Combination With Vitamin C and Extracts of Centella asiatica, Vaccinium myrtillus, and Vitis vinifera for the Reduction of Hemorrhoidal Symptoms in Patients With Grade II and III Hemorrhoidal Disease: A Retrospective Real-Life Study. Front Pharmacol 2022; 12:773320. [PMID: 34970145 PMCID: PMC8712720 DOI: 10.3389/fphar.2021.773320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background and Aim: Several evidences have shown how, in hemorrhoidal disease, phlebotonic flavonoid agents such as quercetin reduce capillary permeability by increasing vascular walls resistance, how rutin and vitamin C have antioxidant properties, and that Centella asiatica has reparative properties towards the connective tissue. A retrospective study was designed in order to evaluate the efficacy and safety of a compound consisting of micronized flavonoids in combination with vitamin C and extracts of C. asiatica, Vaccinium myrtillus, and Vitis vinifera for grade II and III hemorrhoidal disease. Patients and Methods: Data of 49 patients, over 18, who were following a free diet regimen, not on therapy with other anti-hemorrhoid agents, treated with a compound consisting of 450 mg of micronized diosmin, 300 mg of C. asiatica, 270 mg of micronized hesperidin, 200 mg of V. vinifera, 160 mg of vitamin C, 160 mg of V. myrtillus, 140 mg of micronized quercetin, and 130 mg of micronized rutin (1 sachet or 2 tablets a day) for 7 days were collected. Hemorrhoid grade according to Goligher’s scale together with anorectal symptoms (edema, prolapse, itching, thrombosis, burning, pain, tenesmus, and bleeding) both before treatment (T0) and after 7 days of therapy (T7) were collected. Primary outcomes were the reduction of at least one degree of hemorrhoids according to Goligher’s scale assessed by proctological examination and compound safety. The secondary outcome was the reduction of anorectal symptoms assessed by questionnaires administered to patients. Results: Forty-four patients (89.8%) presented a reduction in hemorrhoidal grade of at least one grade (p < 0.001). No adverse events with the use of the compound were noted. A significant reduction was observed in all anorectal symptoms evaluated (p < 0.05). No predictors of response to the compound were identified among the clinical and demographic variables collected. Conclusion: The compound analyzed was effective and safe for patients with grade II and III hemorrhoidal disease according to Goligher’s scale.
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Affiliation(s)
- Antonietta G Gravina
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaele Pellegrino
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Angela Facchiano
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanna Palladino
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Carmelina Loguercio
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessandro Federico
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Dormer L. Celebrating 10 years of the Journal of Comparative Effectiveness Research. J Comp Eff Res 2021; 11:1-5. [PMID: 34872331 DOI: 10.2217/cer-2021-0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Laura Dormer
- Future Medicine Ltd, Unitec House, London, N3 1QB, UK
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