The Effect of Naoxintong Capsule in the Treatment of Patients with Cerebral Infarction and Carotid Atherosclerosis: A Systematic Review and Meta-Analysis of Randomized Trials

OBJECTIVE: Naoxintong capsule (NXT) has been widely used to treat patients with cerebral infarction and carotid atherosclerosis. However, it is uncertain whether there is robust evidence on the effects of NXT for cerebral infarction and carotid atherosclerosis. A systematic review and meta-analysis of randomized trials were performed to assess the efficacy of NXT in the treatment of cerebral infarction and carotid atherosclerosis. METHODS: The Cochrane Library, EMBASE, the Medline database, the Wanfang database, the China National Knowledge Infrastructure, and the VIP database were searched up to January 2018 with no language restrictions. Study selection, data extraction, quality assessment, and data analyses were performed according to the Cochrane standards. RESULTS: Eleven studies (N=1141) in total satisfied the inclusion criteria for the meta-analysis. The results of meta-analysis showed that compared with the conventional therapy alone, NXT combined with conventional therapy could significantly improve national institutes of health stroke scale (NIHSS) score (MD= -3.92, 95%CI: -4.31~-3.52, P<0.00001), plaque area (MD= -0.16, 95%CI: -0.20~-0.13, P<0.00001), carotid intima-media thickness (IMT) (MD= -0.23, 95%CI: -0.26~-0.20, P<0.00001), total cholesterol (TC) (MD= -0.16, 95%CI: -0.79~-0.42, P<0.00001), triglyceride (TG) (MD= -0.69, 95%CI: -0.88~-0.51, P<0.00001), high-density lipoprotein cholesterol (HDL-C) (MD= 0.23, 95%CI: 0.15~0.31, P<0.00001), and low-density lipoprotein cholesterol (LDL-C) (MD= -0.42, 95%CI: -0.58~-0.25, P<0.00001). There were no reported adverse events in the studies. CONCLUSIONS: NXT is an effective and safe therapy option for patients with cerebral infarction and carotid atherosclerosis. However, due to the high clinical heterogeneity and small sample size of the included trials, further standardized preparation, large-scale and rigorously designed trials are needed.