Abstract
BACKGROUND: The study aimed to conduct a network meta-analysis of randomized controlled trials (RCTs) to examine the effectiveness and safety of traditional Chinese patent medicine (TCPM), either used alone or combined with conventional treatment (CT) of chemical drugs, for treating chronic atrophic gastritis (CAG). METHODS: We searched the literature from database creation to December 2023; our primary endpoint was clinical response rate. Secondary outcome measures were the inhibition rate of Helicobacter pylori and clinical symptom score, including pain and noisy scores for the stomach, score for belch and acid reflux, score for the bitter taste and the dry throat, and safety according to total adverse events. Data analyzed using RevMan 5.3, R (v4.0.2), and Stata SE 15.0. Mean differences (MDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes and drug ranking by P-score. Network meta-analysis presented as forest plot and league table. Results reported as MDs/ORs with 95% confidence interval (CI). RESULTS: Our analysis comprised 49 RCTs with 5218 patients. Compared to using CT alone, all TCPMs + CT performed better in improving clinical response rate. The Weifuchun tablet (WFCT) inhibition rate (OR = 9.05; 95% CI = 1.89-43.34; P-score = .92) was relatively high, but only 1 RCT supported this result. WFCT + CT (OR = 2.94; 95% CI = 1.97-4.39; P-score = .57), Qizhiweitong granule (QZWTG) + CT (OR = 2.91; 95% CI = 1.07-7.89; P-score = .55), and Moluodan (MLD) + CT (OR = 2.44; 95% CI = 1.37-4.36; P-score = .43) had certain advantages in inhibiting H pylori compared to using CT alone. Compared with CT, Weisu tablet (WST) + CT (OR = 0.21; 95% CI = 0.05-0.89; P-score = .24) and Xiangshayangwei pill (XSYWP) + CT (OR = 0.41; 95% CI = 0.18-0.92; P-score = .44) were drugs that were less likely to cause adverse reactions. CONCLUSION: Our results demonstrate that, compared to using CT alone, TCPMs combined with CT can improve the clinical response rate in the treatment of CAG. Additionally, some TCPMs combined with CT can enhance the H pylori inhibition rate. WST + CT and XSYWP + CT can even reduce the occurrence of adverse reactions.