Clinical Efficacy,Safety And Cost Of Nine Chinese Patent Medicines Combined With ACEI/ARB In The Treatment Of Early Diabetic Kidney Disease:a Network Meta-analysis

BackgroundDiabetes is considered to be the most common cause of renal microvascular injury.Traditional Chinese patent medicines(CPMs)and simple preparations mentioned in this article include Bailing Capsule(BLC),Compound Xueshuantong Capsule(CXC),Jinshuibao Capsule(JSB),Keluoxin Capsule(KLX),Tripterygium Glycosides(TG),Huangkui Capsule(HKC)Shenyan Kangfu Tablet(SYKFT),Uremic Clearance Granule(UCG),Shenshuaining Tablet(SSNT)have been widely used in China,and have proved to be beneficial to the treatment of diabetes kidney disease(DKD).Therefore,this article intends to evaluate and compare the efficacy,safety and cost of nine CPMs and simple preparations combined with angiotensin receptor blocker(ARB)or angiotensin converting enzyme inhibitor(ACEI)in early DKD patients.MethodsUsing the Cochrane system evaluation method,a comprehensive search was conducted on foreign language databases such as Pub Med,Cochrane Library,Web of Science,and Embase,as well as Chinese databases such as CNKI,Wanfang,China Biomedical,and VIP.The search was conducted until February 2022,with no restrictions on the language,publication year,or blind grouping of literature.Collect and compare literature on the efficacy of different CPMs and ACEI/ARB in early DKD patients.Strictly screen selected literature based on inclusion and exclusion criteria,and conduct quality evaluation,data extraction,and meta-analysis using STATA 14.0 and R 3.5.1.ResultsFinally,160 randomized controlled trials(RCTs)were included,involving 13365 patients and 9 kinds of CPMs and simple preparations.In terms of urinary albumin excretion rate(UAER),the improvement in UCG group was significantly higher than that in ACEI/ARB group(MD=-47,95% CI [-57,-37],SUCRA=98.0%).In terms of overall response rate(ORR),the CXC group showed significant improvement compared to the ACEI/ARB group(RR=1.3,95% CI [1.2,1.5],SUCRA=91.9%).In terms of serum creatinine(Scr)(-19 [-26,-12],SUCRA=99.3%)and adverse effects(AEs)(0.46 [0.17,1.1],SUCRA=82.9%),SSNT was significantly superior to the ACEI/ARB group.BLC has the best efficacy in 24-hour urine protein quantification(24h UTP)(-170 [-260,-83],SUCRA=78.5%)and triglyceride(Trig)(-0.89 [-1.2,-0.53],SUCRA=97.0%).From the cost-benefit analysis of CPMs in China,the cost of TG,SYKFT,and CXC treatment for three months is 108,600,and 648 yuan,respectively,making them the three drugs with the lowest cost.ConclusionUCG and CXC may be the best choice to improve UAER and ORR.SSNT is significantly better than ACEI/ARB group in terms of Scr and AEs.BLC has the best effect on 24 h UTP and Trig.TG is the most cost-effective of the nine CPMs.