Chinese Patent Medicine Injection As Adjunctive Therapy For Angina Pectoris:A Network Meta-analysis And Overview

Objective We sought to compare the efficacy and safety of 14 Chinese patent medicine(CPM)injections when they are respectively combined with routine anti-angina treatment(RT)in patients with angina pectoris(AP).Methods Relevant literatures would be searched in 4 Chinese and 4 English databases.The qualified systematic reviews(SR)and randomized controlled trials(RCT)would be included according to the inclusion and exclusion criteria.After assessing quality of the included SR,we conducted qualitative and quantitative analyses such as network meta-analysis(NMA)and sensitivity analysis on the different outcomes.For all analyses we used Stata 12.0,WinBUGS 1.4,and Microsoft Excel 2013.Results The 14 SR with 20579 participants were included in qualitative synthesis,and the 152 RCT with 15644 participants were included in quantitative synthesis.The quality of the SR and evidences found in the SR was relatively inferior.The courses of treatment were less than or equal to 42 days in the 152 RCT.There weren't enough data to quantitatively analyze the the outcome of cardiovascular events.Relevant NMA and sensitivity analysis showed that the SUCRA values of the 5 interventions[Dan Hong Injection(DHI)+RT,Astragalus Membranceus Injection(AMEI)+RT,Sofren Injection(SOI)+RT,Shenmai Injection(SMI)+RT,and Puerarin Injection(PUI)+RT]were greater than those of the other 10 interventions[RT,Safflower Yellow Injection(SYI)+RT,Danshen Chuanxiongqin Injection(DCI)+RT,Guanxinning Injection(GXNI)+RT,Dengzhan Xixin Injection(DXI)+RT,Compound Danshen Injection(CDI)+RT,Shengmai Injection(SGMI)+RT,Shenxiong Injection(SXI)+RT,Shenfu Injection(SFI)+RT and Kudiezi Injection(KDZI)+RT]in terms of angina improvement,which was robust.There was no statistically significant difference between the 5 interventions(DHI+RT,AMEI+RT,SOI+RT,SMI+RT and PUI+RT)in the improvement of angina symptoms.Funnel plots found the possible publication bias.The 14 CPM injections didn't lead to serious adverse reactions and subjects' withdrawing from the trials,and we couldn't confirm the relative safety of the 14 CPM injections.Conclusion Given the limitations in this overview,it should be used with caution that the 5 interventions(DHI+RT,AMEI+RT,SOI+RT,SMI+RT and PUI+RT)are superior to the other 10 interventions in angina improvement,and there is no statistically significant difference between the 5 interventions.In addition,there is a urgent need to accurately assess the long-term efficacy and safety of different CPM injection plus RT for AP by carrying out future RCT and SR where important clinical outcomes(such as cardiovascular events)are evaluated,and the duration of treatment is enough long.The future RCT should be respectively conducted on the patients with stable and unstable AP,and the future SR should be perfomed according to the PRISMA guideline.