The Adjuvant Efficacy of Angong Niuhuang Pill in the Treatment of Viral Encephalitis: A Meta-Analysis of Randomized Controlled Trials

Summary

Here, we present a protocol to analyze the effectiveness and safety of Angong Niuhuang Pill in the treatment of viral encephalitis.

Abstract

This meta-analysis aims to evaluate the efficacy of Angong Niuhuang Pill (ANP) as an adjuvant therapy in the treatment of viral encephalitis. Seven databases (PubMed, Cochrane Library, Embase, SinoMed, CNKI, VIP and WanFang) were included for literature retrieval from inception to July 2023. Randomized controlled trials comparing ANP plus conventional therapy with conventional therapy alone were eligible. Pooled effect sizes and 95% confidence intervals (CIs) were calculated for evaluating efficacy and safety. Sensitivity analysis and publication bias assessments were performed for analyzing the inconclusiveness of findings. 13 studies involving 1045 cases were included for meta-analysis. Adjuvant treatment with ANP increased the probability of the total effective rate by 17% compared with conventional treatment (Risk ratios (RR) = 1.17, 95%CI [1.08, 1.27]). The disappearance time of clinical syndromes and signs was significantly decreased after adjuvant treatment with ANP, including the time of defervescence (weighted mean difference (WMD) = -1.59, 95%CI [-2.09, -1.09]), the time of consciousness recovery (WMD = -1.79, 95%CI [-2.06, -1.51]), the time of headache disappearance (WMD = -1.51, 95%CI [-1.93, -1.08]), the time of tic disappearance (WMD = -1.88, 95%CI [-2.39, -1.36]). The adjuvant efficacy of ANP for treating viral encephalitis (VE) appears to improve the total effective rate and shorten the disappearance time of clinical syndromes. More high-quality randomized controlled trials (RCTs) are needed to support our findings.

Introduction

Encephalitis is defined as the inflammation of the brain parenchyma with high mortality, characterized by neurological pathological signs, fever, abnormal mental status, and altered electroencephalographic (EEG) and neuroimaging^1,2. The incidence of encephalitis ranges between 7 and 15 cases per 100,000 people^3,4,5. The cause of approximately half of encephalitis cases is unknown, and viral encephalitis (VE) accounts for about 20% to 50% of diagnosed cases^5,6.....

Protocol

1. Protocol registration

1. Register the systemic review.
   NOTE: PROSPERO (Table of Materials) was built by National Institute for Health Research for the registration of systematic review. This systemic review protocol has been registered under the number CRD42022301182.

2. Software installation

1. EndNote software installation
   1. Purchase EndNote software and download the exe file as an insta.......

Discussion

This meta-analysis provides evidence that the adjunctive ANP can improve the total effective rate by 17% in patients with VE. Adjuvant therapy with ANP can significantly shorten the disappearance time of positive pathological signs and symptoms. Xingnaojing (XNJ) injection extracted from ANP is widely used for abnormal consciousness associated with encephalopathy. A recent meta-analysis verified the adjunctive effect of XNJ for treating VE, contributing to an increase in the number of cure cases and shortening the time o.......

Materials

Name	Company	Catalog Number	Comments
PROSPERO	National Institute for Health and Care Research	https://www.crd.york.ac.uk/PROSPERO/
STATA	StataCorp	https://www.stata.com/
TSA	Copenhagen Trial Unit, Centre for Clinical Intervention Research	https://ctu.dk/tsa/downloads/
PubMed	National Library of Medicine	https://pubmed.ncbi.nlm.nih.gov/
Cochrane Library	Cochrane Library	https://www.cochranelibrary.com/
Embase	Elsevier	https://www.embase.com/search/quick
SinoMed	SinoMed	http://www.sinomed.ac.cn/index.jsp
CNKI	China National Knowledge Infrastructure	https://www.cnki.net/
VIP	Chongqing VIP Information Co., Ltd.	http://www.cqvip.com/
WanFang database	Wanfang Data Knowledge Service Platform	https://www.wanfangdata.com.cn/index.html