Soojin Park , Jieun Lee , Seoyeon Jun , Kyuseok Kim
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This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of the combination of ST and EAHM compared to ST alone in the treatment of AA.</p></div><div><h3>Methods</h3><p>We searched 10 databases: PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, KoreaMed, Korean Medical Database (KMBASE), Korean Studies Information Service System (KISS), ScienceON, and Korea Science. Bias was independently assessed using Cochrane Risk of Bias tool (RoB 2.0), and meta-analysis was conducted using Review Manager (Revman) 5.4.1 with the application of random-effect models. The primary outcome was defined as the cure rate.</p></div><div><h3>Results</h3><p>Fifteen studies were selected, and 1,119 participants were included in the study. According to the results of the meta-analysis, a higher cure rate (RR 1.50, 95 % CI : 1.31, 1.71, <em>P</em><0.00001, I<sup>2</sup>=0 %), a higher total efficacy rate (modified Total Efficacy Rate 1 (mTER1); (RR 1.10, 95 % CI: 1,06, 1.15, <em>P</em> < 0.00001, I<sup>2</sup>=0 %), modified Total Efficacy Rate 2 (mTER2); (RR 1.09, 95 % CI: 1.03, 1.16, <em>P</em> = 0.006, I<sup>2</sup>=0 %)), and a lower recurrence rate (RR 0.28, 95 % CI: 0.16, 0.48, <em>P</em><0.00001, I<sup>2</sup>=0 % %) were confirmed in the ST with EAHM group than in the ST group. Low IFN-γ levels and high IL-10 levels were identified in the ST combined with EAHM group. No serious adverse effects were observed during treatment.</p></div><div><h3>Conclusions</h3><p>Compared to ST alone in AA treatment, the combination treatment of ST and EAHM may effectively and safely increase the cure and total efficacy rates and may lower the recurrence rate. 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引用次数: 0
摘要
斑秃（AA）是一种自身免疫性疾病，会降低患者的生活质量并对心理健康产生不利影响。由于类固醇疗法（ST）疗效有限，且有复发风险，因此有人建议将东亚草药疗法（EAHM）与类固醇疗法相结合，作为一种替代治疗方法。目前已有许多随机对照试验（RCT）研究了东亚中药与类固醇疗法联合治疗 AA 的疗效，但尚未对东亚中药与类固醇疗法联合治疗 AA 的疗效与单独使用类固醇疗法的疗效进行比较。本系统综述和荟萃分析旨在评估 ST 和 EAHM 联合治疗 AA 的有效性和安全性。我们检索了 10 个数据库：PubMed、EMBASE、Cochrane Library、中国国家知识基础设施（CNKI）、万方、KoreaMed、韩国医学数据库（KMBASE）、韩国研究信息服务系统（KISS）、ScienceON和韩国科学。使用 Cochrane Risk of Bias 工具（RoB 2.0）对偏倚进行了独立评估，并使用 Review Manager (Revman) 5.4.1 应用随机效应模型进行了荟萃分析。主要结果定义为治愈率。研究选取了 15 项研究，共纳入 1,119 名参与者。根据荟萃分析的结果，较高的治愈率（RR 1.50，95% CI : 1.31, 1.71，P<0.00001，I=0%）、较高的总有效率（修改后的总有效率 1 (mTER1)；（RR 1.10，95% CI : 1,06, 1.15，P<0.00001，I=0%）、改良总有效率2（mTER2）；（RR 1.09，95% CI：1.03，1.16，P=0.006，I=0%）），以及较低的复发率（RR 0.28，95% CI：0.16，0.48，P<0.00001，I=0%）均证实ST伴EAHM组低于ST组。ST联合EAHM组的IFN-γ水平较低，IL-10水平较高。治疗期间未观察到严重的不良反应。与单用 ST 治疗 AA 相比，ST 和 EAHM 联合治疗可有效、安全地提高治愈率和总有效率，并可降低复发率。然而，为了加强这项研究的基础，必须进行更高质量的研究性临床试验。CRD42023397023
The add-on effect of oral East Asian herbal medicine to steroid therapy for alopecia areata: A systematic review and meta-analysis
Introduction
Alopecia areata (AA) is an autoimmune disease that degrades patients' quality of life and adversely affects mental health. Since steroid therapy (ST) has limited efficacy and a risk of recurrence, East Asian herbal medicine (EAHM) combined with ST has been suggested as an alternative treatment. Many randomized controlled trials (RCTs) have been conducted on the efficacy of EAHM combined with ST in AA treatment; however, the efficacy of EAHM combined with ST and the treatment effects of ST alone have not yet been compared. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of the combination of ST and EAHM compared to ST alone in the treatment of AA.
Methods
We searched 10 databases: PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, KoreaMed, Korean Medical Database (KMBASE), Korean Studies Information Service System (KISS), ScienceON, and Korea Science. Bias was independently assessed using Cochrane Risk of Bias tool (RoB 2.0), and meta-analysis was conducted using Review Manager (Revman) 5.4.1 with the application of random-effect models. The primary outcome was defined as the cure rate.
Results
Fifteen studies were selected, and 1,119 participants were included in the study. According to the results of the meta-analysis, a higher cure rate (RR 1.50, 95 % CI : 1.31, 1.71, P<0.00001, I2=0 %), a higher total efficacy rate (modified Total Efficacy Rate 1 (mTER1); (RR 1.10, 95 % CI: 1,06, 1.15, P < 0.00001, I2=0 %), modified Total Efficacy Rate 2 (mTER2); (RR 1.09, 95 % CI: 1.03, 1.16, P = 0.006, I2=0 %)), and a lower recurrence rate (RR 0.28, 95 % CI: 0.16, 0.48, P<0.00001, I2=0 % %) were confirmed in the ST with EAHM group than in the ST group. Low IFN-γ levels and high IL-10 levels were identified in the ST combined with EAHM group. No serious adverse effects were observed during treatment.
Conclusions
Compared to ST alone in AA treatment, the combination treatment of ST and EAHM may effectively and safely increase the cure and total efficacy rates and may lower the recurrence rate. However, to strengthen the basis of this review, higher quality RCTs must be performed.
期刊介绍：
The European Journal of Integrative Medicine (EuJIM) considers manuscripts from a wide range of complementary and integrative health care disciplines, with a particular focus on whole systems approaches, public health, self management and traditional medical systems. The journal strives to connect conventional medicine and evidence based complementary medicine. We encourage submissions reporting research with relevance for integrative clinical practice and interprofessional education.
EuJIM aims to be of interest to both conventional and integrative audiences, including healthcare practitioners, researchers, health care organisations, educationalists, and all those who seek objective and critical information on integrative medicine. To achieve this aim EuJIM provides an innovative international and interdisciplinary platform linking researchers and clinicians.
The journal focuses primarily on original research articles including systematic reviews, randomized controlled trials, other clinical studies, qualitative, observational and epidemiological studies. In addition we welcome short reviews, opinion articles and contributions relating to health services and policy, health economics and psychology.
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