Systematic Review and Meta-Analysis on the Effect of Transdermal Preparations of Sinomenium Acutum on Rheumatoid Arthritis

Abstract

Abstract. Objective:. We evaluated the efficacy and safety of transdermal preparations of Sinomenium acutum (SA) for rheumatoid arthritis (RA). Methods:. Randomized controlled trials (RCTs) of SA transdermal preparations for RA were extracted from relevant databases and screened in accordance with the inclusion criteria. The Cochrane System Evaluation Manual (version 5.1.0) was used to assess the quality of the included trials. We used the Cochrane Review Manager (version 5.4) to conduct the meta-analysis. Results:. Six trials comprising 436 patients (220 patients in the treatment group and 216 patients in the control group) were analyzed. The meta-analysis indicated that SA transdermal preparations in combination with disease-modifying antirheumatic drugs (DMARDs) enhanced the overall effect (odds ratio [OR] 3.97, 95% confidence interval [CI] [2.25, 7.00], P<0.00001), decreased visual analogue scale (VAS) results (mean difference [MD] –0.64, 95% CI [–1.20, –0.09], P=0.02), decreased laboratory indexes including the erythrocyte sedimentation rate (ESR) (MD –4.36, 95% CI [–5.63, –3.08], P<0.00001) and C-reactive protein (CRP) (MD –3.6, 95% CI [–3.99, –3.21, P<0.00001]), and decreased the Disease Activity Score-28 (DAS28) (MD –0.41, 95% CI [–0.78, –0.03], P=0.03). The results suggest that combination therapy did not shorten the duration of morning stiffness (DMS; standardized MD [SMD] –6.13, 95% CI [–17.33, 5.06], P=0.28) or reduce rheumatoid factor (RF) laboratory indexes (SMD –0.85; 95% CI [–2.19, 0.49], P=0.21). Only one study reported adverse reactions, and thus, it was difficult to determine whether adverse drug reactions in the combination therapy group were significantly different from those in the control group. Conclusion:. We found that SA transdermal preparations combined with DMARDs may have greater clinical efficacy than DMARDs for RA. More well-designed and high-quality RCTs are required to verify the findings and determine whether transdermal preparations cause fewer adverse events.