Network Meta-analysis Of Acupuncture Treatments For Chemotherapy-induced Myelosuppression

[Objective]To evaluate the efficacy and safety of acupuncture treatments for chemotherapy-induced myelosuppression and optimize the best treatment by using network Meta-analysis,and to provide evidence-based medical evidence for follow-up studies and clinical application.[Methods]Four English-language databases（PubMed,Embase,CENTRAL,CINAHL）and four Chinese-language databases（CNKI,Wanfang,VIP,CBM）were searched from the database inception through December 31,2021.Two researchers independently screened literatures,extracted data by inclusion and exclusion criteria and evaluate the quality of included studies by Cochrane bias risk assessment tool.The GeMTC0.14.3 software which based on Bayesian Markov chain Monte Carlo method was used for network Meta-analysis.The relative effect size of each intervention was presented by ladder tables,superiority ranking by probability maps and small sample effect or publication bias by funnel plots.[Results]A total of 36 trials were included,with 2933 patients,involving seven interventions including electroacupuncture,manual acupuncture,moxibustion,acupoint injection,acupoint application,acupoint catgut embedding and blank control.The network Meta-analysis results showed that:（1）in terms of preventing the incidence of grade Ⅰ-Ⅳ haematological toxicity,manual acupuncture（OR=0.1,95%CI=[0.03,0.31]）,moxibustion（OR=0.33,95%CI=[0.18,0.62]）,acupoint injection（OR=0.47,95%CI=[0.22,0.95]）,acupoint catgut embedding（OR=0.14,95%CI=[0.02,0.64]）are better than blank control and the differences are statistically significant.The top three therapies are manual acupuncture,acupoint catgut embedding,moxibustion.（2）in terms of preventing the incidence of grade Ⅲ-Ⅳhaematological toxicity,moxibustion（OR=0.30,95%CI=[0.10,0.66]）,acupoint injection（OR=0.11,95%CI=[0.01,0.50]）,acupoint application（OR=0.18,95%CI=[0.05,0.52]）are better than blank control and the differences are statistically significant.The top three therapies are acupoint injection,acupoint application,moxibustion.（3）in terms of improving leukocyte,electroacupuncture（MD=1.45,95%CI=[0.88,2.10]）,moxibustion（MD=0.84,95%CI=[0.35,1.33]）,acupoint injection（MD=1.61,95%CI=[0.94,2.27]）are better than blank control and the differences are statistically significant.The top three therapies are acupoint injection,electroacupuncture,moxibustion.（4）in terms of improving platelets,electroacupuncture（MD=41.58,95%CI=[27.77,55.42]）,moxibustion（MD=28.39,95%CI=[14.48,40.89]）are better than blank control and the differences are statistically significant.The top three therapies are electroacupuncture,moxibustion,manual acupuncture.（5）in terms of improving hemoglobin,moxibustion（MD=5.97,95%CI=[2.27,9.34]）,acupoint injection（MD=8.41,95%CI=[3.76,11.44]）are better than blank control and the differences are statistically significant.The top three therapies are acupoint injection,moxibustion,acupoint application.（6）in terms of improving neutrophils,electroacupuncture（MD=1.61,95%CI=[0.68,2.72]）,moxibustion（MD=0.81,95%CI=[0.06,1.69]）,acupoint injection（MD=1.28,95%CI=[0.30,2.24]）are better than blank control and the differences are statistically significant.The top three therapies are electroacupuncture,acupoint injection,moxibustion.Finally about safety evaluation,only two studies reported the occurrence of adverse reactions,including 2 cases of fainting during moxibustion and unknown cases of numbness of lower limbs after acupoint injection,with no influence after common treatment.[Conclusion]Acupuncture treatment can prevent the incidence of haematological toxicity,among which manual acupuncture may be the best acupuncture therapy in preventing theⅠ-Ⅳ haematological toxicity,while acupoint injection in Ⅲ-Ⅳ haematological toxicity.In terms of blood cell counts,acupoint injection may have the best efficacy in improving leukocyte and hemoglobin,and electroacupuncture may have the best efficacy in improving platelets and neutrophils.It is suggested to make a reasonable choice according to clinical situations.Acupuncture treatment has low incidence of adverse reactions and good safety.