Effectiveness and safety of seven oral Chinese patent medicines as adjuvant therapy for cancer-related anemia: A systematic review and network meta-analysis of randomized controlled trials

To evaluate the effectiveness and safety of seven oral Chinese patent medicines (CPMs) as adjuvant therapy for cancer-related anemia (CRA) by network meta-analysis (NMA). A literature search to obtain randomized controlled trials (RCTs) of seven oral CPMs in the adjuvant treatment of CRA was conducted in multiple databases from the inception to April 2022. The RevMan5.3 and R 4.1.1 software were used for NMA. We ultimately included 29 RCTs with 2140 patients. Traditional meta-analysis showed that Fufang E'jiao syrup (FFEJS), Shengxuebao mixture (SXBM), Shengxuening tablets (SXNT), Jianpi Shengxue granules (JPSXG), and Yixuesheng capsule (YXSC) combined with basic Western treatment (BWT) could improve the hemoglobin (HGB) level. JPSXG combined with BWT could improve the red blood cell (RBC). FFEJS combined with BWT improved the Karnofsky performance status (KPS). NMA showed that FFEJS, JPSXG, SXBM, and SXNT plus BWT improved HGB better than Shengxue tablets (SXT) plus BWT, with top three ranking results being JPSXG plus BWT > SXNT plus BWT > FFEJS plus BWT. FFEJS plus BWT, JPSXG plus BWT, SXBM plus BWT, SXNT plus BWT, and SXT plus BWT improved RBC better than BWT, with top three ranking results being SXNT plus BWT > JPSXG plus BWT > FFEJS plus BWT. In terms of the KPS score, compared with SXT plus BWT, FFEJS, JPSXG, SXBM, SXNT, and Yizhong Shengxue capsule (YZSXC) plus BWT had higher KPS, with top three ranking results being SXBM plus BWT > JPSXG plus BWT > FFEJS plus BWT. Our NMA demonstrated that seven oral CPMs used as adjuvant treatment of CRA had a definite clinical effect. JPSXG not only increases the levels of HGB and RBC to enhance the clinical effect but also improves patients' quality of life. More accurate conclusions need to be verified by more high-quality RCTs.