Methodological and reporting quality evaluation of meta-analyses on the Chinese herbal preparation Zheng Qing Feng Tong Ning for the treatment of rheumatoid arthritis

Liang et al. BMC Complementary Medicine and Therapies https://doi.org/10.1186/s12906-020-02978-5 (2020) 20:195 BMC Complementary Medicine and Therapies RESEARCH ARTICLE Open Access Methodological and reporting quality evaluation of meta-analyses on the Chinese herbal preparation Zheng Qing Feng Tong Ning for the treatment of rheumatoid arthritis Mingge Liang1†, Lan Yan1†, Zhigang Mei1,2†, Yanan Luo1, Xiaoqiang Hou3 and Zhitao Feng1,3* Abstract Background: Zheng Qing Feng Tong Ning (ZQFTN) is a sinomenine (SIN) preparation that has been used in clinical practice. Our study aimed to assess the methodological and reporting quality of meta-analyses on the Chinese herbal formula ZQFTN for the treatment of rheumatoid arthritis (RA). Methods: Systematic searches were carried out with the 5 following electronic databases from inception to July 2019: China National Knowledge Infrastructure (CNKI), Wanfang, VIP database for Chinese technical periodicals (VIP), Cochrane Library and PubMed. The quality of the methodology and reporting was measured with the assessment of multiple systematic reviews 2 (AMSTAR 2) scale, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: Eight studies were identified. Among the 16 items of the AMSTAR 2 scale, four items were optimally reported (“Y” =100% of the items), and another four items were poorly reported (“Y” =0% of the items). Only 2 studies received a good overall score (“Y” ≥50% of the items). Regarding the PRISMA statement, the scores of 5 studies were lower than the average score (17.69), indicating that the quality of the reports was very low. In terms of the GRADE, none of the 61 results were of high quality (0.0%). Fifteen results were of medium quality (25%), 34 were of low quality (55%), and 12 were of very low quality (20%). Among the five downgrading factors, deviation risk (n = 61, 100%) was the most common downgrading factor, followed by inconsistency (n = 30, 50%), publication bias (n = 17, 28%), inaccuracy (n = 11, 18%) and indirectness (n = 0, 0%). (Continued on next page) * Correspondence: † Mingge Liang, Lan Yan and Zhigang Mei contributed equally to this work. 1 Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University, Yichang 443002, Hubei, China 3 Institute of Rheumatology, the First College of Clinical Medical Sciences, China Three Gorges University, Yichang 443003, Hubei, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Liang et al. BMC Complementary Medicine and Therapies (2020) 20:195 Page 2 of 12 (Continued from previous page) Conclusions: The methodological and reporting quality of the meta-analyses and systematic reviews in the included studies are less than optimal, and researchers should undergo additional training and follow the AMSTAR 2 scale, PRISMA statement and GRADE to design high-quality studies in the future. Keywords: Sinomenine, Zheng Qing Feng Tong Ning, Rheumatoid arthritis, Meta-analysis, Methodology, Reporting quality Background Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease that may trouble patients as a result of morning stiffness, painful joints, chronic inflammation, synovitis, irrecoverable joint damage, and the presence of autoantibodies [1, 2]. The prevalence of RA in adults worldwide is 0.04–1.6%, with significant national differences [3]. In China, RA has an estimated prevalence of 0.42% and affected more than 5 million patients in 2018 [4]. The pathogenesis of RA is complex, and the course of RA is lingering; RA is characterized by symmetrical, chronic, and progressive polyarthritis, which, as the disease progresses, leads to the destruction of articular cartilage, bone, and capsule, resulting in irreversible joint deformity and incapacitation [5, 6]. At present, the common medications for RA include glucocorticoids (GCs), nonsteroidal anti-inflammatory drugs (NSAIDs), and disease-modifying antirheumatic drugs (DMARDs) [7–9]. Some studies have reported that sinomenine (SIN), Tripterygium wilfordii Hook, Simiao pill, Wang-bi tablet, total glucosides of paeony (TGP) [10–15] and other traditional Chinese medicines and their related prescriptions possess beneficial effects and show good clinical efficacy in the treatment of RA, supporting why traditional Chinese medicines and prescriptions have received increasing attention [16–18]. Zheng Qing Feng Tong Ning (ZQFTN) is one of the SIN preparations, and it is an alkaloid monomer extracted from the traditional Chinese herb Sinomenium acutum and has been used in clinical practice [19]. Some studies have shown that SIN may have a good effect on the treatment of RA (e.g., less pain and an improvement in physical function or morning stiffness) [20, 21]. Mechanistic studies have indicated that SIN can alleviate collagen-induced arthritis (CIA) via the inhibition of angiogenesis [22], induce the generation of intestinal Treg cells, relieve arthritis by activating the aryl hydrocarbon receptor [23] and suppress RA progression by modulating the secretion of various inflammatory cytokines and the monocyte/macrophage subpopulation [24]. Currently, ZQFTN series products are one of the Chinese medicine varieties used for the domestic treatment of RA, and ZQFTN is a modern Chinese medicine preparation [25]. Studies have shown that SIN has anti-inflammatory, analgesic and immunosuppressive effects [26], which indicates that it may play a crucial role in the treatment of RA. A multitude of clinical trials on the efficacy and safety of ZQFTN in the treatment of RA have been performed in mainland China and other countries. The relevant methods and quality analyses of the reports may prom (...truncated)