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Journal of Chinese Integrative Medicine ›› 2012, Vol. 10 ›› Issue (1): 25-34.doi: 10.3736/jcim20120105

• Systematic Review • Previous Articles     Next Articles

Systematic review and meta-analysis of randomized controlled trials comparing Chinese patent medicines Compound Danshen Dripping Pills and Di’ao Xinxuekang in treating angina pectoris

Ng Cui-shan1,2(),Wang Shan-ping1,2,Cheong Jun-long1,2,Wu Yu-dan1,2,Jia Yong-liang1,2,Leung Siu-wai1,2,3   

  1. 1. State Key Laboratory for Quality Research in Chinese Medicine, University of Macau, Macao 999078, China
    2. Institute of Chinese Medical Sciences, University of Macau, Macao 999078, China
  • Received:2011-08-17 Accepted:2011-11-07 Online:2012-01-20 Published:2018-09-21
  • Contact: Ng Cui-shan E-mail:swleung@umac.mo

BACKGROUND: Chinese patent medicines Compound Danshen Dripping Pills (DSP) and Di’ao Xinxuekang (DXK) capsules were both found effective in treating angina pectoris. However, there is no systematic review comparing their efficacy.OBJECTIVE: This systematic review aims to compare the efficacy of DSP and DXK in treating angina pectoris based on randomized controlled trials (RCTs) comparing their efficacy.SEARCH STRATEGY: RCT reports published between 1994 and 2011 were retrieved from databases including China Doctoral Dissertations Full-text Database, Chinese Journal Full-text Database, China Master’s Theses Full-text Database, Wanfang Data, Cochrane Library, Excerpta Medica Database, ScienceDirect, MEDLINE (EBSCOhost) and PubMed. The last retrieval was performed on April 7, 2011.INCLUSION CRITERIA: RCT reports comparing the effects of DSP and DXK were included, regardless publishing language.DATA EXTRACTION AND ANALYSIS: Included RCT reports were assessed for their study quality by using the Jadad scale and the Cochrane risk of bias tool. Data including overall effect and electrocardiography (ECG) improvements were extracted from the included RCTs for meta-analysis. The effect sizes based on overall and ECG diagnosis were measured by odds ratio (OR) and 95% confidence interval (CI). Subgroup analysis and sensitivity analysis were also performed.RESULTS: Nine RCT reports with 926 participants were included. Eight were scored 2 and the other one was scored 4 by using the Jadad scale. The OR between DSP and DXK based on overall diagnosis was 2.06 (95% CI: 1.03-4.12; Poverall=0.04). Six out of the nine included RCTs reported ECG data. The OR between DSP and DXK based on the ECG diagnosis was 1.92 (95% CI: 1.23-3.00; PECG =0.004). The OR results were stable under subgroup analysis and sensitivity analysis.CONCLUSION: DSP was consistently more effective than DXK according to meta-analysis, which was verified by subgroup analysis and sensitivity analysis. However, more RCTs of higher quality are needed for further confirmation.

Key words: compound, traditional Chinese drugs, angina pectoris, meta-analysis, randomized controlled trials

Figure 1

Flow diagram of literature search and selectionCJFD: Chinese Journal Full-text Database; CMTD: China Master’s Theses Full-text Database; CDMD: China Doctor Dissertations Full-text Database; DSP: Compound Danshen Dripping Pills; DXK: Di’ao Xinxuekang; RCT: randomized controlled trial."

Table 1

Main characteristics of included studies"

Study Year of
publication
Trial
period
Baseline
comparability
Sample
size
Outcome
measure
Treatment
duration
(d)
DSP
dosage (g)
DXK
dosage (g)
Number of
adverse events
DSP DXK
Chen JW[17] 2005 NR Reported 124 Overall,
ECG
60 0.81 0.36 2 3
Fan YL[18] 2008 2006/1 to
2007/11
Reported 234 Overall,
ECG
84 0.81 0.6 0 23
Huang ZH[19] 2009 2006 to 2008 NR 80 Overall 60 0.81 0.6 0 1
Huang YN[20] 2007 2000/1 to
2006/2
Reported 80 Overall,
ECG
56 0.81 0.6 NR NR
Qin PS et al[21] 2000 1998/5 to
1999/8
Reported 124 Overall,
ECG
28 0.81 0.6 NR NR
Wang D[22] 2010 NR Reported 60 Overall,
ECG
28 0.81 2.1 0 0
Yan L[23] 2007 2002/3 to
2005/11
Reported 60 Overall,
ECG
56 0.81 0.6 NR NR
Yang M et al[24] 2007 NR NR 74 Overall 56 0.81 0.3 to 0.6 0 0
Zhang XC[25] 2002 2001/3 to 12 NR 90 Overall 30 0.54 0.6 NR NR

Table 2

Quality evaluation of included studies"

Study Randomization concealment Blinding Withdrawals and drop-outs Jadad score
Chen JW[17] 0 0 1 2
Fan YL[18] 2 0 1 4
Huang ZH[19] 0 0 1 2
Huang YN[20] 0 0 1 2
Qin PS et al[21] 0 0 1 2
Wang D[22] 0 0 1 2
Yan L[23] 0 0 1 2
Yang M et al[24] 0 0 1 2
Zhang XC[25] 0 0 1 2

Figure 2

A forest plot of overall outcome measures"

Figure 3

A forest plot of electrocardiography outcome measure"

Table 3

Sensitivity analysis of overall and ECG outcome measures"

Index Number of participants OR 95% CI Z value P value I2 χ2 P (heterogeneity)
Overall effect[18-21,23-25] 742 2.08 [0.88, 4.90] 1.68 0.09 69% 19.60 0.000 3
ECG[18,20,21,23] 498 2.19 [1.47, 3.24] 3.88 0.000 1 4% 3.12 0.37
Overall effect[17,18,20-25] 846 2.81 [1.64, 4.78] 3.78 0.000 2 36% 10.87 0.14

Table 4

Subgroup analysis of overall outcome measures"

Index Subgroup Number
of RCTs
Number of
participants
OR Wilcoxon
test
95% CI Zvalue P value I2 χ2 P
(heterogeneity)
Sample size ≤80 5 354 1.27 W=5 [0.43, 3.79] 0.43 0.66 62% 10.46 0.03
>80 5 1 006 4.11 P=0.220 7 [2.17, 7.76] 4.35 <0.0001 56% 9.02 0.06
Duration <56 d 3 274 1.49 W=6 [0.41, 5.49] 0.61 0.54 60% 4.97 0.08
≥56 d 7 1 086 2.91 P=0.438 6 [1.36, 6.22] 2.75 0.006 71% 20.88 0.002

Table 5

Subgroup analysis of ECG outcome measures"

Subgroup Number
of RCTs
Number of
participants
OR Wilcoxon
test
95% CI Zvalue P value I2 χ2 P
(heterogeneity)
Samplesize ≤80 3 200 1.24 W=1 [0.63, 2.41] 0.62 0.53 21% 2.53 0.28
>80 3 484 2.61 P=0.126 6 [1.76, 3.87] 4.76 <0.000 1 0 2.00 0.37
Duration <56 d 2 184 1.10 W=1 [0.44, 2.76] 0.21 0.84 49% 1.95 0.16
≥56 d 4 498 2.57 P=0.164 9 [1.75, 3.78] 4.79 <0.000 01 0% 2.54 0.47

Table 6

Statistics of adverse events"

Study Sample size Number of adverse events Incidence of adverse events
DSP DXK DSP DXK DSP DXK
Chen JW[17] 62 62 2 3 0.032 0.048
Fan YL[18] 130 104 0 23 0 0.221
Huang ZH[19] 40 40 0 1 0 0.025
Wang D[22] 30 30 0 0 0 0
Yang M et al[24] 36 38 0 0 0 0
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