Efficacy of Chinese Medicine Injection for Cardiotoxic Injury of Anthracycline Chemotherapy Drugs: A Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Chinese medicine injections (CMIs) are widely used in the prevention and treatment of cardiotoxicity caused by anthracycline chemotherapeutic drugs. However, it is uncertain that CMIs are more effective in combating the cardiotoxicity of anthracyclines. The aim of this Network Meta-analysis (NMA) was to compare the treatment effects of various CMIs in order to determine the best CMI for the prevention and treatment of cardiac damage from anthracyclines. METHODS: The Chinese Journal Full Text Database (CNKI), Wanfang Database, Chinese Science and Technology Journal Full Text Database (VIP), Chinese Biomedical Literature Database (CBM), PubMed, Web of Science, and Cochrane Library databases were searched to screen randomized controlled trials (RCTs) of CMIs against cardiotoxicity of anthracycline-based chemotherapeutic drugs. The search time frame was all from the establishment of the database to October 1, 2021. After independent screening of the literature, extraction of information and evaluation of the risk of bias of the included studies by two evaluators, mesh meta-analysis was performed using RevMan 5.3, Stata 15.1, and ADDIS 1.16.8 software. RESULTS: A total of 33 studies including 2783 patients, including 1410 cases in the experimental group and 1373 cases in the control group were included, and six CMIs were extracted, namely, Shenfu injection, Shenmai injection, Shenqi Fuzheng injection, Shengmai injection, Xinmailong injection, and Haungqi injection. The results of the reticulated meta-analysis showed that in terms of ST-T segment (ECG change) change rate, Haungqi injection, Shenfu injection, and Xinmailong injection were superior. In terms of lowering CK-MB, Huangqi Injection and Shenqi Fuzheng injection were superior. In terms of improving Left ventricular ejection fraction (LVEF), Shenfu injection, Huangqi Injection, and Shengmai injection were more effective than other injections. In terms of improving LVEDD, Shengmai injection, Huangqi Injection, and Xinmailong injection have advantages. CONCLUSION: The six CMIs included in this study are effective against cardiotoxicity caused by anthracycline-based chemotherapeutic agents. Huangqi Injection and Shenfu injection are both superior in improving various outcome indicators. There is still a need for larger, high-quality randomized controlled trials (RCTs) to compare the various CMIs in a more refined way.