| Objective:The efficacy and safety of kidney-tonifying method combined with chemotherapy and chemotherapy alone in the treatment of multiple myeloma(MM)were analyzed through Meta,in order to provide evidence-based basis for the treatment of MM with integrated traditional Chinese and Western medicine.Methods:A systematic search was conducted in major databases including Pubmed,The Cochrane library,Embase,Web of Science,China National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),VIP Database for Chinese Technical Periodicals,Wanfang Digital Knowledge Service Platform,for randomized controlled trials(RCTs)on the efficacy and safety of tonifying the kidney method combined with chemotherapy for the treatment of MM.The search was conducted up to October 31 st,2022,and the results were entered into End Note X9 for literature management.Duplicate studies were removed using the software’s deduplication function,and the final inclusion and exclusion criteria were applied by reviewing the titles and abstracts according to pre-determined standards.Quality evaluation was conducted on the included studies,and data extracted from the literature were summarized and analyzed using Rev Man 5.3 software.Results:1.16 articles were included,with a total sample size of 938 cases.The sample sizes of individual articles ranged from 38 to 120 cases,with 469 cases in the experimental group and469 cases in the control group.After manually tallying the intervention of traditional Chinese medicine in the included literature,the frequency of Chinese herbal medicines from high to low were as follows: Rehmannia glutinosa,Dodder Seed,Licorice,Psoralea Fruit,Astragalus,Xu Duan,Safflower,Hedyotis,Dogwood,Drynaria,Chinese Angelica,and Poria.2.The results of the Meta-analysis indicate that in terms of primary outcome measures,the objective remission rate was observed in 16 studies with an odds ratio(OR)of 2.62 and a 95%confidence interval(CI)of [1.92,3.58].The objective remission rate was further divided into subgroups based on age and chemotherapy cycle,with OR of 2.78 and 95% CI of [1.87,4.12]for the age subgroup <60 years,and OR of 2.38 and 95% CI of [1.43,3.97] for the age subgroup ≥60 years.As for the chemotherapy cycle subgroup,OR was found to be 2.28 and95% CI was [1.32,3.96] for the subgroup with a chemotherapy cycle of less than 3 months,and OR was found to be 2.80 and 95% CI was [1.91,4.09] for the subgroup with a chemotherapy cycle of 3 months or more.In addition,the therapeutic effect of TCM syndrome was evaluated in 7 studies with an OR of 4.85 and 95% CI of [2.73,8.59].The quality of life was assessed in 7 studies with an OR of 4.53 and 95% CI of [2.17,9.45].Furthermore,in 5 studies,the MD of bone pain symptoms was-1.49 and the 95% CI was[-1.82,-1.15].Regarding the secondary outcome measures,plasma cell proportion was evaluated in 11 studies and showed high heterogeneity.Sensitivity analysis could not determine the source of heterogeneity,but subgroup analysis suggested that age and chemotherapy cycle might be the sources of heterogeneity,with an MD of-6.58 and a 95% CI of [-10.06,-3.10].M protein was evaluated in 10 studies and also showed high heterogeneity.Neither sensitivity nor subgroup analysis could identify the source of heterogeneity,with an MD of-6.70 and a 95% CI of [-10.04,-3.35].The MD of β2-microglobulin was-1.13 and the 95% CI was [-1.80,-0.46].The MD of blood creatinine was-8.18 and the 95% CI was[-10.34,-6.02].The MD of blood urea nitrogen was-2.74 and the 95% CI was [-3.01,-2.48].The MD of hemoglobin was 7.87 and the 95% CI was [7.14,8.6].The MD of platelets was14.22 and the 95% CI was [10.69,17.76].The MD of neutrophils was 2.53 and the 95% CI was [2.41,2.64].The MD of IL-6 was-1.53 and the 95% CI was [-1.86,-1.21].The MD of blood calcium was-0.26 and the 95% CI was [-0.37,-0.15].The MD of osteoblasts was 0.17 and the 95% CI was [0.08,0.25].The MD of osteoclasts was-0.07 and the 95% CI was [-0.09,-0.05].Regarding safety indicators: there were 6 cases of cardiac damage,9 cases of gastrointestinal reactions,6 cases of peripheral neuropathy,3 cases of infection,2 cases of hematologic toxicity,2 cases of renal dysfunction,and 5 cases of hepatic dysfunction.No heterogeneity was detected in the tests,and the integrated effect size was OR=0.19,95%CI=[0.08,0.43] for cardiac damage,OR=0.34,95% CI=[0.21,0.56] for gastrointestinal reactions,OR=0.28,95% CI=[0.16,0.47] for peripheral neuropathy,OR=0.35,95% CI=[0.15,0.82] for infection,OR=0.27,95% CI=[0.11,0.65] for hematologic toxicity,OR=0.24,95%CI=[0.05,1.21] for renal dysfunction,and OR=0.24,95% CI=[0.10,0.57] for hepatic dysfunction.The 95% CI of renal dysfunction includes 1,indicating no statistically significant difference in efficacy between the two groups.The funnel plot reveals potential publication bias in several studies regarding the proportion of plasma cells,M protein,hemoglobin,and abnormal liver function.Bias in publication may exist,while no such testing has been conducted in studies with limited literature on β 2 microglobulin,platelets,neutrophils,osteoblasts,osteoclasts,infection,hematologic toxicity,and renal function.No publication bias was found in the remaining literature.Conclusions:1.The combination of kidney-tonifying therapy and chemotherapy in treating multiple myeloma(MM)improves objective response rate,traditional Chinese medicine syndrome efficacy rate,quality of life,hemoglobin,platelet,neutrophil,osteoblast,relieves bone pain symptoms,reduces plasma cell proportion,M protein,β2 microglobulin,blood creatinine,blood urea nitrogen,IL-6,blood calcium,osteoclast,infection incidence,alleviates chemotherapy-related toxic and side effects such as cardiac damage,gastrointestinal reactions,peripheral neuropathy,hematologic toxicity,and hepatic dysfunction more effectively than chemotherapy alone.The efficacy of kidney-tonifying traditional Chinese medicine prescriptions in treating MM is clear.2.It is recommended to use kidney-tonifying Chinese herbal medicine based on syndrome differentiation,with Rehmanniae Radix Praeparata,Cuscutae Semen,Psoraleae Fructus,Epimedii Herba,Corni Fructus,and Drynariae Rhizoma as the main ingredients.3.However,due to the low overall quality of the literature included,more high-quality evidence from evidence-based medicine is needed to support the conclusion of the meta-analysis. |
PDF Full Text Request