title: Chinese herbal medicine as adjuvant treatment to chemotherapy for multidrug-resistant tuberculosis (MDR-TB): A systematic review of randomised clinical trials.
abstract: BACKGROUND
  Chinese herbal medicine (CHM) has been increasingly used as an adjuvant treatment for multi-drug resistant tuberculosis (MDR-TB) in China. To inform clinical practice, we performed a systematic review on the beneficial effect and safety of CHM for MDR-TB.
  
  
  METHODS
  We searched six electronic databases for randomised clinical trials (RCTs) of CHM for MDR-TB. We used RevMan 5.2 software for data analyses with effect estimates as risk ratio (RR) with 95% conﬁdence interval (CI).
  
  
  RESULTS
  30 RCTs involving 3374 participants with MDR-TB were included. The methodological quality was generally poor in terms of risk of bias. Meta-analyses favoured CHM plus chemotherapy on sputum bacteriological conversion rate compared with chemotherapy alone after initiation of treatment (6th mos: RR 1.27, 95% CI 1.14 to 1.41, n = 12; 12th mos: RR 1.30, 95% CI 1.11 to 1.52, n = 6; 18th mos: RR 1.19, 95% CI 1.11 to 1.27, n = 9). Compared with chemotherapy alone, meta-analyses showed benefit from CHM plus chemotherapy on lung lesions resorption rate (6th mos: RR 1.10, 95% CI 0.91 to 1.32, n = 5; 12th mos: RR 1.26, 95% CI 1.10 to 1.45, n = 4; 18th mos: RR 1.19, 95% CI 1.08 to 1.32, n = 7) and cavity closure rate (12th mos: RR 1.48, 95% CI 1.06 to 2.07, n = 2; 18th mos: RR 1.26, 95% CI 1.04 to 1.53, n = 5), relapse rate (RR 0.28, 95% CI 0.16 to 0.50, n = 4), and abnormal liver function (RR 0.56, 95% CI 0.46 to 0.69, n = 14). No serious adverse effects were reported.
  
  
  CONCLUSIONS
  CHM as an adjuvant to anti-TB chemotherapy may have beneficial effect for MDR-TB in terms of bacteriological and radiological outcomes, and is relatively safe. However, due to poor methodological reporting of the included trials, a confirmative conclusion needs to be supported by further robust clinical trials.
authors: Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China; School of Basic Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang, Liaoning, 110847, China. Electronic address: linhan616@126.com.
authors: Mei
authors: M
authors: Wang
authors: The Second Department of Respiratory Medicine, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi District, Shenyang, Liaoning, 110022, China. Electronic address: gx0621@126.com.
authors: Xin
authors: X
authors: Guan
authors: School of Basic Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang, Liaoning, 110847, China. Electronic address: chemcy@mail.dlut.edu.cn.
authors: Yuan
authors: Y
authors: Chi
authors: London South Bank University, 103 Borough Road, London, SE1 0AA, UK. Electronic address: nicky.robinson@lsbu.ac.uk.
authors: Nicola
authors: N
authors: Robinson
authors: Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China; School of Basic Medicine, Liaoning University of Traditional Chinese Medicine, 79 Chong Shan Dong Lu, Huanggu District, Shenyang, Liaoning, 110847, China. Electronic address: jianping_l@hotmail.com.
authors: Jian-Ping
authors: JP
authors: Liu
mesh_terms: D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000382:microbiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D004365:Drugs, Chinese Herbal
keywords: Chinese herbal medicine; Meta-analysis; Multidrug resistant tuberculosis; Randomised clinical trials; Systematic review