SynthesisFrontiers in pharmacology2026
Which commercial Chinese polyherbal preparations combined with ACEI/ARB is effective and safe for IgA nephropathy? A systematic review and network meta-analysis.
Synthesis in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: This systematic review and network meta-analysis (NMA) evaluates and compares the efficacy and safety of six commercial Chinese polyherbal preparations (Bailing Capsule (BL), Huangkui Capsule (HK), Tripterygium Glycosides (TG), Jinshuibao Capsule (JSB), Huobahuagen Tablet (HBHG), and Shenyan Kangfu Tablet (SYKF)) combined with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB) for treating Immunoglobulin A nephropathy (IgAN), offering updated evidence to support clinical decision-making. Methods: We conducted a systematic literature search in PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and VIP Database for Technology Periodicals (up to 20 October 2025) for randomized controlled trials (RCTs) that enrolled patients with IgAN and compared the combination of six commercial Chinese polyherbal preparations with ACEI/ARB against ACEI/ARB therapy alone. To synthesise the evidence from the network of treatments, we performed frequentist network meta-analyses and subsequently assessed the certainty of evidence through the systematic application of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The study is registered in the PROSPERO database (CRD420251175045). Results: A total of 70 RCTs involving 4855 patients were included in this systematic review and NMA. The overall risk of bias was high among the included studies. Compared with ACEI/ARB alone, BL combined with ACEI/ARB probably improves overall response rate (OR: 3.27, 95% CI: 2.21 to 4.84; moderate certainty) and reduces 24-h urine protein quantification (MD: -0.83 g, 95% CI: -1.21 to -0.44; moderate certainty). HBHG combined with ACEI/ARB may reduce serum creatinine (MD: -26.63 μmol/L, 95% CI: -47.91 to -5.35; low certainty), while TG combined with ACEI/ARB may reduce blood urea nitrogen (MD: -2.53 mmol/L, 95% CI: -4.54 to -0.52; moderate certainty). BL combined with ACEI/ARB may also improve hemoglobin (MD: 9.41 g/L, 95% CI: 8.18 to 10.64; low certainty). No convincing differences were observed in adverse drug reactions between most commercial Chinese polyherbal preparations combined with ACEI/ARB (very low to moderate certainty), although HK combined with ACEI/ARB showed a relatively higher incidence. Sensitivity analyses supported the robustness of findings. Egger's test suggested potential publication bias for overall response rate and 24-h urine protein quantification. Conclusion: In patients with IgAN, BL combined with ACEI/ARB may outperform other Chinese- Biomedicine regimens in reducing 24-h urine protein quantification, with all combinations potentially superior to ACEI/ARB alone. However, evidence certainty remains low, highlighting the need for more rigorous, long-term RCTs for validation. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251175045, PROSPERO: CRD420251175045.
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