| Objective:1.To evaluate the clinical efficacy and safety of Huangqi Guizhi Wuwu Decoction for perventing Oxaliplatin-induced peripheral neurotoxicity by systematic review,to provide evidence-based medical evidence for the treatment of peripheral neurotoxicity induced by oxaliplatin.2.To discuss the drawbacks of Huangqi Guizhi Wuwu Decoction for perventing Oxaliplatin-induced peripheral neurotoxicity and provide methodological for Chinese medicine clinical studies.Methods:To search the CKNI,VIP,CBM,Wan Fang Database,Pubmed,and EMBASE from inception through to October 2017 for clincal randomized controlled trials for prevention of Oxaliplatin-induced peripheral neurotoxicity by Huangqi Guizhi Wuwu Decoction,supplemented by manual retrieval,including dissertation and conference papers.Combined with inclusion criteria and exclusion criteria,the literatures of repeated retrieval and publication were eliminated.The methodological quality of eligible studies was evaluated using the Cochrane Risk Bias Assessment tool(Version 5.1.0)released by the Cochrane Collaboration,then extract relevant data from the included trials.Using Reviewer Manager 5.3 software to calculated the summarized effects.Results:1.20 publications in total were included.The majority of the studies have the following problems:unstandardized randomization,unmentioned allocation scheme hiding and blind method,and unreasonable processing of missing data.So,the methodological quality of all the trials was low.2.Total incidence of peripheral neurotoxicity:2.l"chemotherapy+Huangqi Guizhi Wuwu Decoction"vs"chemotherapy alone":11 studies were included with a total of 761 patients..Meta-analysis illustrated:RR=0.55,95%CI:[0.48,0.62],P<0.00001?Sensitivity analysis suggested that the results were reliable and there was no obvious publication bias.2.2"chemotherapy+Huangqi Guizhi Wuwu Decoction" vs"chemotherapy+western medicine":Five studies were included with a total of 268 patients..Meta-analysis illustrated:RR=0.53,95%CI:[0.40,0.71],P<0.0001.The result had low sensitivity,stable results and no obvious publication bias.2.3"chemotherapy+Huangqi Guizhi Wuwu Decoction+western medicine"vs"chemotherapy+westem medicine":Two studies were included with a total of 120 patients..Meta-analysis illustrated:RR=0.88,95%CI:[0.71,1.08],P=0.21.No statistical significance.3.Incidence of severe peripheral neurotoxicity:3.1"chemotherapy+Huangqi Guizhi Wuwu Decoction"fs"chemotherapy alone":14 studies were included with a total of 937 patients..Meta-analysis illustrated:RR=0.15,95%CI:[0.08,0.27],P<0.00001.Sensitivity analysis suggested that the results were reliable and there was no obvious publication bias.3.2"chemotherapy+Huangqi Guizhi Wuwu Decoction"vs"chemotherapy+westem medicine":7 studies were included with a total of 379 patients..Meta-analysis illustrated:RR=0.41,95%CI:[0.14,1.21],P=0.11.No statistical significance.3.3"chemotherapy+Huangqi Guizhi Wuwu Decoction+western medicine,"vs"chemotherapy+western medicine":Two studies were included with a total of 120 patients..Meta-analysis illustrated:RR=0.60,95%CI:[0.08,4.41],P=0.62.No statistical significance.4.The effects on nerve conduction:Two studies were included with a total of 102 patients.Meta-analysis illustrated:MD=4.92,95%CI:[6.13,10.94],P<0.00001.Sensitivity analysis suggested that the results were reliable and there was no obvious publication bias.5.The incidence of adverse events:there were only 2 reports of low-grade bone marrow suppression and low-grade blood toxicity,and there was no statistical significance.There were no reports of other adverse events.Conclusion:1.Whether oral or external administration of Huangqi Guizhi Wuwu Decoction can effectively prevent the incidence of Oxaliplatin-induced peripheral neurotoxicity.And it has a good clinical efficacy.2.Compared with western medicine treatment,Huangqi Guizhi Wuwu Decoction has a better efficiency in preventing the incidence of Oxaliplatin-induced peripheral neurotoxicity.But,there is no evidence that Huangqi Guizhi Wuwu Decoction is better than western medicine in preventing severe peripheral neurotoxicity.3.The existing studies can not prove the synergistic effect of Huangqi Guizhi Wuwu Decoction combined with conventional western medicine in the prevention and treatment of neurotoxicity and severe peripheral neurotoxicity.4.Huangqi Guizhi Wuwu Decoction effectively alleviates the effect of oxaliplatin on nerve conduction.5.The safety of Huangqi Guizhi Wuwu Decoction in clinic is good.6.At present,the research on traditional Chinese medicine generally has low quality,such as unstandardized randomization,unmentioned allocation scheme hiding and blind method,and unreasonable processing of missing data,insufficient attention paid to follow-up cases.7.Because of the limit of included studies'quantity and quality,the above conclusion can only serve as a reference.It should be further confirmed by more multi-center,large sample and high standards of clinical RCTs. |
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