Research - Tongxinluo
Is Tongxinluo More Effective Than Isosorbide Dinitrate in Treating Angina Pectoris? A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Yongliang Jia, Feifei Bao, Fangyi Huang, and Siu-wai Leung
Tongxinluo (TXL), consisting of 12 Chinese Materia Medica items catalogued in the Chinese Pharmacopoeia, is commercially available in China, South Korea, and Russia. Hundreds of randomized clinical trials (RCTs) on TXL in treating cardiovascular diseases were conducted and published in China. This study provides a comprehensive Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)–compliant systematic review with sensitivity and subgroup analyses to evaluate the evidence about whether TXL is more effective than isosorbide dinitrate (ISDN) in treating ischemic heart disease, particularly angina pectoris.
RCTs published between 1996 and 2010 on TXL versus ISDN in treating angina pectoris for at least 4 weeks were retrieved from eight bibliographical databases (e.g., MEDLINE,® PubMed, Chinese National Knowledge Infrastructure, Cochrane Library, and WanFang Data). The quality of RCTs was assessed with the Jadad scale. Meta-analysis was performed to estimate the overall effects based on symptomatic and electrocardiographic (ECG) improvements. Subgroup analysis, sensitivity analysis, and meta-regression were conducted on the study characteristics of RCTs.
Twenty (20) RCTs with a total of 1936 participants were included after eligibility assessment. The Jadad score of all included studies was 2. The means of summary odds ratios (ORs) for comparing TXL and nitrates were 3.30 (95% confidence interval [CI] 2.37–4.58) by symptoms (n=20) and 2.38 (95% CI 1.846–3.09) by ECG (n=18). There was a significant correlation of ORs between symptoms and ECG (ρ=0.77 and p=0.00026). Subgroup analysis, sensitivity analysis, and meta-regression found no significant difference in overall effects among all study characteristics except the years of publication (p=0.0409).
The meta-analysis of 20 eligible RCTs demonstrates moderate evidence that TXL is more effective than ISDN for treating angina pectoris. This result warrants further RCTs of multicenters/countries, larger sample sizes, and higher quality.
Source : The Journal of Alternative and Complementary Medicine
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Tongxinluo capsule for coronary heart disease: a systematic review
- Zhou Zhong-Ran,
- Tang Hai-Qin,
- Li Jie-Hua,
- Yang Lin-Lin,
- Hu Hao
Department of Geriatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
Objective To assess the effectiveness and safety of tongxinluo capsule for coronary heart disease.
Methods Trials were located electronic searches of the Cochrane Library (Issue 4, 2010), PubMed (1966 to April 2010), Wangfang (1984 to April 2010), CNKI (1979 to April 2010), VIP (1989 to April 2010), and CBM (1978 to April 2010). Randomised controlled trials (RCTs) and quasi-RCTs of tongxinluo capsule for coronary heart disease were included. Quality assessment and data extraction were conducted by two reviewers independently. Disagreement were resolved through discussion. All data were analysed using Review Manager 5.0.
Results 13 studies involving a total of 1 496 participants met the inclusion criteria. Meta analysis results showed that: compared with nitrate esters, tongxinluo capsule for the coronary heart disease group had superiority in many aspects such as amelioration according to curative effect: tongxinluo capsule is better than isosorbide dinitrate [RR 0.50 and 95% CI 0.36 to 0.70], than isosorbide mononitrate [RR 0.19 and 95% CI 0.12 to 0.30], total efficacy [RR 0.34 and 95% CI 0.26 to 0.44, p<0.00001], the two groups had significant difference; Effectiveness according to EKG: tongxinluo capsule is better than isosorbide denigrate [RR 0.55 and 95% CI 0.46 to 0.66], than isosorbide mononitrate [RR 0.58 and 95% CI 0.48 to 0.70], total efficacy [RR 0.56 and 95% CI 0.49 to 0.64, p<0.00001], the two groups had significant difference; the tongxinluo group has a lower rates of adverse effect than itrate esters group. Meta-analysis results showed that the incidence rates of adverse effect [RR 0.33 and 95% CI 0.20 to 0.53], p<0.00001], the two groups had significant difference.
Conclusion Now we have evidence to indicate that tongxinluo capsule can improve curative effect no worse than isosorbide dinitrate or isosorbide mononitrate, and have a lower rates of adverse effect. But more large scale multi center randomised trials are still needed.
Source : Journal Heart and Education in Heart
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