Chinese herbal medicine for epidermal growth factor receptor inhibitor-induced skin rash in patients with malignancy: An updated meta-analysis of 23 randomized controlled trials. (December 2019) - Chen, Zhi-Qiang
Highlights: This updated meta-analysis to assess the efficacy and safety of CHM or EGFRIs induced skin rash in patients with malignancy using Revman 5.3. We identified the common herbs for skin rash using the Traditional Chinese Medicine Inheritance Support System. CHM therapy had therapeutic effects on the treatment of EGFRIs induced skin rash and the adverse events were tolerable. The methodological quality is limited owing that the majority of the included trials were of high or unclear risk of bias. More high-quality and rigorous trials are required to confirm our findings. Abstract: Objective: To systematically review and evaluate the effectiveness of Chinese herbal medicine (CHM) therapy for epidermal growth factor receptor inhibitor (EGFRI)-induced skin rash in patients with malignancy. Methods: The electronic databases of Medline, PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, VIP Chinese Sci-tech Journal, Wan Fang, and Chinese Biomedicine were searched from their inception to 31 st September 2018. Randomized controlled trials (RCTs) investigating the effectiveness of CHM in improving EGFRI-induced skin rash were analyzed by Review Manager 5.3. Results: Twenty-three eligible RCTs with 1392 participants were identified and divided into four subgroups according to different treatment rules of Traditional Chinese Medicine (TCM) and different controls. CHM (dispel wind, clear heat, and eliminate dampness), the representative formula Xiao Feng San, is more effective than western medicine in improving and curing skin rash(RR, 95%CI: 1.46, 1.26–1.70 and 1.65, 1.24–2.20); CHM (nourish yin, clear heat, and remove toxin for eliminating blood stasis), the representative formula Yang Fei Xiao Zhen Tang, is more effective than western medicine in improving skin rash(RR, 95%CI: 1.45, 1.10–1.92). CHM (clear lung and purge heat, cool blood, and remove toxic substance) is more effective in improving and curing skin rash, compared with the western medicine group (RR, 95%CI: 1.42, 1.21–1.67 and 2.43, 1.23–4.81) or the blank control group(RR, 95%CI:2.37, 1.21–4.63 and 2.98, 1.20–7.41). The side effects of CHM are all mild and tolerable. Sensitivity analysis indicates that the results of the study are stable. The asymmetry funnel plots described that publication bias of this research may exist. Conclusion: The limited evidence suggests that CHM exhibits clinical effectiveness and good safety on the treatment of EGFRI-induced skin rash. Large-sample RCTs are required to further determine the effectiveness of CHM.