Comparative Effectiveness Of Different Oral Chinese Herbal Prescription For Primary Sjogren’s Syndrome: A Network Meta-analysis

Objective: 1.To compare the efficacy and safety of oral Chinese herbal formula and hydroxychloroquine(HCQ)in the treatment of primary Sjogren’s syndrome(pSS)by Meta-analysis;2.To compare the efficacy of different Chinese herbal formulas in the treatment of pSS by network Meta-analysis.Methods: According to the principle of Picos,the key words were made,and the literatures about clinical randomized controlled trials of oral Chinese medicine prescription versus HCQ in the treatment of PSS were searched in major databases until February 1,2021.After literature screening and data extraction were completed by two researchers according to the pre-established inclusion and exclusion criteria,the total clinical response rate and the incidence of adverse reactions were taken as the outcome indicators.The direct Meta-analysis was performed by STATA16.0 software,and the network Metaanalysis was performed by combining with the GEMTC program package of R3.6.3 software.Results: Finally,42 Chinese literatures and 36 different traditional Chinese medicine prescriptions were included.A total of 2957 patients with pSS were included,of which 36 were lost to follow-up.There was no heterogeneity and publication bias between all literatures.The results of direct Metaanalysis showed that the total effective rate of oral Chinese medicine in the treatment of pSS was significantly better than that of HCQ Group [or = 1.20,95% CI(1.01,1.39),P = 0.00],and the safety was also good,but there was no statistical significance [or =-0.32,95% CI(-0.84,0.21),P = 0.24].There is no closed loop in this network Meta-analysis,and there is no need for consistency test.The homogeneity and similarity among the studies are good.The fixed effect model is used for network Meta-analysis.The results show that the clinical total effective rate of the four treatment methods is ranked as Jianpi Huoxue Method > Yiqi Yangyin method > Yangyin method > HCQ,but there is no statistical significance among the three.The clinical total effective rate of the seven traditional Chinese medicine prescriptions in Yangyin method is higher than HCQ The effective rate ranked as Yangyin Huoxue Method > Ziyin Liqi method > nourishing liver and kidney method > Yangyin Qingre method > Yangyin Qingre Huoxue Method >Yangyin Shengjin method > Yangyin Huashi method > HCQ,in which the clinical total effective rate of Yangyin Huashi method was not significantly different from that of HCQ [or = 1.14,95% CI(0.49,P < 0.05),62)],only the method of nourishing yin and activating blood circulation was significantly better than the methods of nourishing yin and clearing heat,nourishing yin and generating fluid,nourishing yin and resolving dampness and nourishing yin and clearing heat and activating blood circulation,the other two methods had no statistical significance.The clinical total effective rate of the four TCM prescriptions in the Yiqi Yangyin method was ranked as Yiqi Yangyin Qingre Huoxue Jiedu method > Yiqi Yangyin Huoxue Method > Yiqi Yangyin Qingre Huoxue Method > Yiqi Yangyin Qingre method > HCQ.There was no significant difference between the clinical total effective rate of the Yiqi Yangyin Qingre method and the HCQ group [or = 1.72,95% CI(0.80,3.71)],and there was no statistical significance between the four TCM prescriptions.Conclusion: 1.Oral Chinese medicine treatment of pSS can obtain good clinical effect,and good safety;2.Xueyu syndrome may run through the whole course of pSS,and the late course is often accompanied by Zaore and Zaodu syndrome.In order to get better curative effect,we should pay more attention to the treatment of concurrent syndrome in clinical syndrome differentiation.