Comparative effectiveness of traditional Chinese medicine injections combined with ACEI/ARB for diabetic nephropathy: A systematic review and network meta-analysis

Aijing Li¹Maoying Wei¹Dan Yin¹Yiting Tang¹Chan Wu¹Yijia Jiang¹Churan Wang¹Jingyi Guo¹Anning Sun¹Xin Gu¹Yanbing Gong^2*

• ¹Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
• ²Beijing University of Chinese Medicine, Beijing, Beijing Municipality, China

Aim of the study: This systematic review and network meta-analysis aimed to evaluate the comparative effectiveness of traditional Chinese medicine injections (TCMIs; singular: TCMI) combined with Angiotensin-converting enzyme inhibitor or angiotensin Ⅱ receptor blockers for diabetic nephropathy. Methods: Ten databases were searched. Primary endpoints were urinary albumin excretion rate (UAER) and serum creatinine (Scr). Secondary endpoints indicators were blood urea nitrogen (BUN), urinary β2-microglobulin, total cholesterol, triglyceride, systolic blood pressure, and total effective rate. Cochrane Risk of Bias tool (version 2.0) was used to evaluate the quality of the studies. The GRADE method was used to assess the whole network. Finally, Stata 16.0 software was used to perform network meta-analysis. Results: A total of 99 randomised controlled trials and ten TCMIs were included for analysis. Based on the surface under the cumulative ranking curve values, the efficacy of the combination group was better than that of the control group. For the primary endpoints, Shuxuetong injection and Shenkang injection were excellent in reducing UAER and Scr respectively. For others, Danshen injection was the most effective for total effective rate and BUN; Shuxuetong injection, Yinxingdamo injection, Danshen-chuanxiongqin injection and Shuxuening injection were the most effective for total cholesterol, β2-microglobulin, triglyceride and systolic blood pressure, respectively. In terms of dual indicators, for UAER and Scr, Danshen injection may be the most effective treatment. In addition, no significant adverse reactions were reported in the relevant studies on Huangqi injection and Gegensu injection, while Yinxingdamo injection, Danshen-chuanxiongqin injection, Shenkang injection, Shuxuetong injection and Kudiezi injection demonstrated varying degrees of adverse reactions. Conclusion: This study indicates that, when combined with ACEI/ARB, Shuxuetong injection, Shenkang injection, Danshen injection, Danshenchuanxiongqin injection, Yinxingdamo injection, and Shuxuening injection may confer advantages in improving DN indicators. However, due tolimitations in the methodological quality of the included studies (especially deficiencies in randomisation and blinding) and the critical lack of reporting on key information regarding TCMI components, the reliability of these findings is compromised.