| Objective: To evaluate the effectiveness of Chinese medicine in treating patients with MG by balancing confounding factors of the clinical effectiveness of Chinese medicine using propensity score matching.Methods:In this study,a multicentre prospective cohort study was used to select patients with myasthenia gravis who met the inclusion and exclusion criteria from 11 hospitals seen between 2021 and September 2022.Patients were allowed to choose the most appropriate treatment option based on their condition and needs,which included a combination of Chinese and Western medicine treatment and Western medicine treatment.Patients in the combined Chinese and Western medicine treatment cohort will be treated with a combination of conventional Western medicine(cholinesterase inhibitors and/or immunosuppressants)and Chinese herbal formulas as recommended by the TCM guidelines,while patients in the Western medicine treatment cohort will be treated with conventional Western medicine.The patient should also note the specific composition of the prescription,the dosage and whether any adverse events or reactions occurred while taking the drug.Records were made to compare patients’ pre-and post-treatment scores for their condition.The main indicators were the quantitative myasthenia gravis score(QMG),the absolute/relative myasthenia gravis score(ARS-MG),the myasthenia gravis specific muscle strength test(MMT),the strength for daily living scale(MG-ADL),the Myasthenia Gravis Daily Life Strength Scale(MG-QOL15),and to compare the rate of adverse events between the two groups before and after treatment,and the analysis of the dosage of other drugs such as cholinesterase inhibitors,glucocorticoids and immunosuppressants,etc.,in order to objectively assess the effectiveness of the treatment.to objectively evaluate the effectiveness and factors affecting the treatment of myasthenia gravis by combining Chinese and Western medicine.SPSS 25.0 was used for statistical analysis,and chi-square analysis and rank sum test were applied to compare differences between the general information of the two cohorts and the laboratory data variables;general patient information was used as covariates,and propensity scores were calculated using R,and the covariates included in the study were calculated using R for the propensity score weighting method for a 1: 1 matching,with the bracket value set to 0.02,and the data after accurate matching,for the comparison of effectiveness.Results:After exclusion of patients who met the exclusion criteria,142 cases in the final combined Chinese and Western medicine treatment cohort and 65 cases in the Western medicine treatment cohort.There were 41 precisely matched cases in the Chinese and Western medicine treatment cohort and in the Western medicine treatment cohort after propensity score.The presence or absence of other self-inflicted diseases,use of hormones or immunosuppressants before enrolment,distribution of disease duration,MGFA typing and mean age of patients in the different groups were different(p < 0.05)and not comparable.After the propensity score,there was no significant difference in the general information between the two groups,which were comparable.No significant difference(P>0.05)was observed between the QMG,ARS,MMT,ADL,and QOL scores of the two groups of patients before treatment.However,the intra-group comparison between the two groups after treatment revealed a reduction in all scores,and the differences were all statistically significant(P<0.01);the results of the inter-group comparison before and after treatment: GMQS scores,MMT scores,ADL scores,QOL scores,relative ARS scores: 1month,3 months,6 months were not significantly different between the two groups(P>0.05).The TCM treatment cohort had a statistically significant difference(P<0.05)in the total daily dose of bromipyridamole tablets,the proportion of glucocorticoids,total daily dose,and the proportion of non-hormonal immunosuppressants,total daily dose compared with the Western treatment cohort.no specific discomfort was reported in patients in either group during observation,and after 6 months of treatment and follow-up of patients in both groups,7 of the Western medicine treatment cohort developed full moon faces.Conclusion:After removing confounding factors using the propensity score matching method,there was a significant reduction in absolute pre-and post-treatment scores in both cohorts for the GMQ,ARS,MMT,ADL and QOL scores up to 6 months of treatment,with no significant difference between the group comparisons.There was no significant difference in the total efficacy rate between the two groups after 6 months of treatment.From this study,it is clear that TCM treatment can effectively improve the clinical symptoms and quality of life of myasthenia patients,with relatively few adverse effects and a good safety profile.Regarding the available results,it was concluded that TCM guidelines combined with conventional Western medicine for MG patients had similar efficacy at 6 months compared to Western medicine,and the duration of application of hormone doses used in Chinese and Western medicine treatment,the proportion of immunosuppressive drugs used,was significantly lower than that of the Western medicine treatment cohort,and there were fewer adverse drug reactions and side effects,which deserves to be promoted in clinical practice. |
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