Herbal medicine for Asymptomatic Hyperuricemia: A systematic review and network meta-analysis

Ye Min¹Fengqin Xiao^2,3Ling Zhou⁴Meng Fan¹Jinli Luo^2,3*Linhua Zhao^5*

• ¹School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
• ²Graduate College, Beijing University of Chinese Medicine, Beijing, China
• ³Guangdong Yifang Pharmaceutical Co., Ltd., Foshan, China
• ⁴Chengdu University of Chinese Medicine, Chengdu, China
• ⁵Institute of Metabolic Diseases, Guang’ anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China

Background: There is still controversy in the medical community about whether asymptomatic hyperuricemia (AH) requires drug treatment. Herbal medicines (HM) are considered a potential intervention for the treatment of hyperuricemia. Objectives: This study aimed to investigate the efficacy and safety of HM for asymptomatic HUA. Materials and Methods: A Bayesian network meta-analysis was conducted for patients with asymptomatic HUA in randomized controlled trials identified in PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, China Biomedical Database (CBM), and China Science and Technology Journal Database (VIP) were searched from their inception to Jan 1, 2025. Outcomes included the serum uric acid (SUA), secondary outcomes (TC, TG, HDL or HDL-C, LDL or LDL-C, and traditional Chinese medicine symptom scores), and adverse events. This study was registered in PROSPERO (CRD42024459357). Results: The systematic evaluation of thirty randomized trials compared 22 HM formulations for HUA management. All evaluated HM formulations except Qinluo Huazhuo Formula demonstrated significant SUA reduction versus non-drug therapy (NDT), achieving effect sizes spanning from 0.04 (95%CI 0.02-0.08) to 0.63 (95%CI 0.47-0.86). Probabilistic ranking identified Xuezhikang capsule as the most effective agent for SUA reduction (99.4%), with concurrent improvements in lipid profiles including TC, TG, and HDL levels.Therapeutic benefits extended to TCM symptom scores across all interventions (OR range 3.15-28.44), suggesting broader treatment potential for HUA management. No serious adverse events were documented throughout the trials. Conclusions: HM interventions demonstrate potential efficacy in managing AH, showing significant reductions in SUA levels alongside beneficial effects on lipid profile modulation and TCM symptom alleviation. While these findings suggest therapeutic promise, the preliminary nature of the evidence necessitates rigorous validation through methodologically robust clinical trials.