title: A Chinese patent medicine, Shexiang Baoxin Pill, for Non-ST-elevation acute coronary syndromes: A systematic review.
abstract: BACKGROUND
  Shexiang Baoxin Pill (SXBXP) is a well-known Chinese patent medicine, widely used for Non-ST-elevation acute coronary syndromes (NSTE-ACS). It is composed of seven materia medicas or extracts (Moschus, Radix Ginseng, Calculus Bovis, Cortex Cinnamomi, Styrax, Venenum Bufonis and Borneolum Syntheticum).
  
  
  OBJECTIVE
  This study is aimed to systematically review the relevant randomised controlled trials (RCTs) to determine the efficacy and safety of SXBXP for long-term management of NSTE-ACS.
  
  
  METHODS
  A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. All randomised controlled trials (RCTs) comparing long-term Shexiang Baoxin Pill with conventional treatment, with outcome measures relating to efficacy and safety were selected. Primary clinical outcome was the risk of cardiovascular events, secondary outcomes were hospitalizations, angina symptoms, electrocardiogram (ECG) measurements, and adverse events.
  
  
  RESULTS
  Eleven RCTs recruiting 1389 patients were included, the overall risk of bias of the included trials is high and the quality poor. Compared with conventional treatment alone, long-term Shexiang Baoxin Pill plus conventional treatment might be more effective in lowering the risk of cardiovascular events (RR=0.36, 95% CI 0.26-0.49, <0.00001), hospitalizations (RR=0.38, 95% CI 0.21-0.67, P=0.0009), and improving angina symptoms (RR=1.19, 95% CI 1.13-1.26, P<0.00001), ECG measurements (RR=1.25, 95% CI 1.13-1.39, P<0.00001). Overall rate of adverse events was not elevated (P=0.43).
  
  
  CONCLUSIONS
  From the available evidence, SXBXP added to conventional treatment may have beneficial effects on the long-term outcomes of NSTE-ACS, without serious adverse events. However, given the high risk of bias and low quality of the included trials, currently, there is no adequate evidence to draw any conclusions about its routine use. Large, methodologically-sound trials are needed to further assess its effects.
authors.affiliation: State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, PR China; Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, PR China. Electronic address: zhouzhou0512@126.com.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Jiangsu Engineering Laboratory for Research and Industrialization of Empirical Formulae, Nanjing University of Chinese Medicine, Nanjing, PR China. Electronic address: shweixing@hotmail.com.
authors.forename: Weixing
authors.initials: W
authors.lastname: Shen
authors.affiliation: State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, PR China; Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, PR China. Electronic address: llyu@must.edu.mo.
authors.forename: Lili
authors.initials: L
authors.lastname: Yu
authors.affiliation: Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, PR China. Electronic address: 516053211@qq.com.
authors.forename: Cong
authors.initials: C
authors.lastname: Xu
authors.affiliation: State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, PR China; Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, PR China. Electronic address: qbwu@must.edu.mo.
authors.forename: Qibiao
authors.initials: Q
authors.lastname: Wu
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000818:Animals; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D008419:Materia Medica / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D008516:Medicine, Chinese Traditional / Q000009:adverse effects / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012306:Risk
chemical_list: D004365:Drugs, Chinese Herbal; D008419:Materia Medica; C526712:shexiang baoxin
keywords: Acute coronary syndromes; Bufalin (PubChem CID: 9547215); Cinnamic acid (PubChem CID: 444539); Efficacy; Gamabufotalin (PubChem CID: 259803); Ginsenoside Rb1 (PubChem CID: 118987129); Ginsenoside Rc (PubChem CID: 12855889); Ginsenoside Rg1 (PubChem CID: 441923); Meta-analysis; Muscone (PubChem CID: 10947); Resibufogenin (PubChem CID: 10063); Safety; Shexiang Baoxin Pill; Systematic review