Effectiveness and Safety of Chinese Medicine for Idiopathic Pulmonary Fibrosis: A Systematic Review and Meta-Analysis.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness and safety of Chinese medicine (CM) for Idiopathic pulmonary fibrosis (IPF) patients. METHODS: To screened relevant articles, PubMed, Cochrane Library, Excerpta Medica Datase (EMBASE), China National Knowledge Infrastructure (CNKI), Chinese VIP Information (VIP), Wanfang Database and Chinese Biomedical Database (CBM) were searched in English or Chinese until December 2015 for randomized controlled trials, which compared CM treatment (CM group) with Western medicine or placebo (control group) on IPF. The outcome measures included acute exacerbation, pulmonary function, the St George's respiratory questionnaire (SGRQ) scores, 6-minute walk test (6MWT) distance, adverse events and mortality. RESULTS: This meta-analysis included 25 randomized controlled trials involving 1,471 patients. Compared with the control group, CM group was superiori in reducing the risk of exacerbation [relative risk (RR)=0.40, 95% CI 0.22 to 0.72, P<0.05], improving in forced expiratory volume in one second (FEV1) [standard mean difference (SMD)=0.62, 95% CI 0.40 to 0.84, P<0.01] and diffusion capacity for carbon monoxide (DLCO, SMD=0.40, 95% CI 0.22 to 0.58, P<0.01), but there was no significant difference in vital capacity (VC, SMD=0.10, 95% CI-0.12 to 0.31, P>0.05). This meta-analysis also revealed that CM therapy significantly decreased the SGRQ score (SMD=-0.60, 95% CI-1.14 to-0.05, P<0.05) and improved 6MWT distance (SMD=0.59, 95% CI 0.34 to 0.84, P<0.01), compared with the control group. Meanwhile, CM therapy was associated with a low incidence of adverse effects (RR=0.19, 95% CI 0.08 to 0.43, P<0.01). However, there was no significant difference in mortality (RR=0.24, 95% CI 0.05 to 1.10, P>0.05) between CM and control groups. CONCLUSIONS: The pooled outcomes suggest that CM treatment appears benefit in reducing the risk of exacerbation, improving lung function and decreasing the incidence of adverse effects and enhancing the quality of life. However, the outcomes were limited because of the low quality of the included studies. More rigorous clinic trials need to be carried out to provide sufficient and accurate evidence in the future.