Chinese herbal medicine as adjuvant treatment to chemotherapy for multidrug-resistant tuberculosis (MDR-TB) : a systematic review of randomised clinical trials

Introduction: Chinese herbal medicine (CHM) has been increasingly used as an adjuvant treatment for multi-drug resistant tuberculosis (MDR-TB) in China. To inform clinical practice, we performed a systematic review on the beneficial effect and safety of CHM for MDR-TB. Methods: We searched six electronic databases for randomised clinical trials (RCTs) of CHM for MDR-TB. We used RevMan 5.2 software for data analyses with effect estimates as risk ratio (RR) with 95% confidence interval (CI). Results: 30 RCTs involving 3374 participants with MDR-TB were included. The methodological quality was generally poor in terms of risk of bias. Meta-analyses favoured CHM plus chemotherapy on sputum bacteriological conversion rate compared with chemotherapy alone after initiation of treatment (6th mos: RR 1.27, 95% CI 1.14 to 1.41, n = 12; 12th mos: RR 1.30, 95% CI 1.11 to 1.52, n = 6; 18th mos: RR 1.19, 95% CI 1.11 to 1.27, n = 9). Compared with chemotherapy alone, meta-analyses showed benefit from CHM plus chemotherapy on lung lesions resorption rate (6th mos: RR 1.10, 95% CI 0.91 to 1.32, n = 5; 12th mos: RR 1.26, 95% CI 1.10 to 1.45, n = 4; 18th mos: RR 1.19, 95% CI 1.08 to 1.32, n = 7) and cavity closure rate (12th mos: RR 1.48, 95% CI 1.06 to 2.07, n = 2; 18th mos: RR 1.26, 95% CI 1.04 to 1.53, n = 5), relapse rate (RR 0.28, 95% CI 0.16 to 0.50, n = 4), and abnormal liver function (RR 0.56, 95% CI 0.46 to 0.69, n = 14). No serious adverse effects were reported. Conclusions: CHM as an adjuvant to anti-TB chemotherapy may have beneficial effect for MDR-TB in terms of bacteriological and radiological outcomes, and is relatively safe. However, due to poor methodological reporting of the included trials, a confirmative conclusion needs to be supported by further robust clinical trials.