The Efficacy and Safety of Fuzheng Traditional Chinese Medicine Injections in the Treatment of Acute Ischemic Stroke: A Systematic Review and Network Meta-analysis

Qiaosheng RenLinlin Guo^*Peichi ZhangXuefeng WuYingzhi XuKegang Cao^*

• Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China

Objective: The primary objective of this network meta-analysis (NMA) was to compare and rank the relative efficacy and safety of 7 distinct fuzheng traditional Chinese medicine injections (TCMIs) combined with conventional treatment (CT), against CT, for the management of acute ischemic stroke (AIS).. The overarching hypothesis was that while TCMIs +CT as a class provide benefit over CT alone, their therapeutic profiles differ. Methods: The Cochrane Library, Embase, PubMed, Web of science, CNKI, Wanfang, VIP and SinoMed were comprehensively searched from their inception to January 11, 2025, for randomized controlled trials (RCTs) focusing on the use of fuzheng TCMIs +CT to treat AIS. The quality of the included RCTs was assessed using the risk-of-bias 2 (RoB2) tool.. NMA in the frequentist framework were designed to access the efficacy of different fuzheng TCMIs. Results: A total of 70 RCTs involving 6,227 patients were enrolled. The study showed that MLN, HQ, SHM, CWJ, SF, and SM combined with CT significantly improved performance compared with CT in treating AIS. In terms of the increase in the clinical efficacy rate, MLN + CT was most likely to be the best course of action, so as CWJ+CT in terms of NIHSS, BI, blood lipids, LCV, and IL-6. CWJ+CT was associated with the lowest rate of ADRs, though the evidence base for safety comparisons remains limited. Additionally, MLN + CT was most likely to be the best treatment in PV, FIB and mRS. Given that SF + CT ameliorated ADL and CRP, it was most likely to be the best course of action. The treatment that was most likely to be the best in terms of HCV was SHM + CT. Considering the decrease in TNF-α, SM + CT had the best chance of being the best treatment. Conclusions: The combination of CT and TCMIs had a more beneficial impact on the treatment of AIS. CWJ + CT and MLN + CT both performed best. However, these findings should be interpreted with caution due to the methodological limitations of the included trials.. Therefore, to substantiate the findings, more excellent research is required.