Efficacy and Safety of Chinese Herbal Medicine for Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Controlled Trials

This study aims to evaluate the effectiveness and safety of oral Chinese herbal medicine (CHM) in the treatment of knee osteoarthritis (KOA). Systematic review and meta-analysis of randomized controlled trials (RCTs). A computer was used to retrieve all RCTs of CHM in the treatment of KOA from 7 databases (PubMed; Embase; Cochrane Central Register of Controlled Trials; China National Knowledge Infrastructure; Chinese VIP Information Database; Chinese Biomedical Database and Wanfang Med Database) from the establishment to August 2021. The literature was organized using NoteExpress, and literature screening and data extraction were conducted by two researchers independently by the inclusion and exclusion criteria. Quality evaluation was performed using GRADE, and the meta-analysis was performed using RevMan5.4. A total of 31 RCTs and 3115 cases are included. The following meta-analysis results are observed: (1) WOMAC: CHM vs. placebo (SMD = −0.87, 95% CI: −1.27 to −0.47, P < 0.0001), CHM vs. Western medicine (SMD = −1.64, 95% CI: −2.09 to −1.19, P < 0.00001), and CHM + Western medicine vs. Western medicine (SMD = −2.17, 95% CI: −3.01 to −1.33, P < 0.00001); (2) VAS: CHM vs. Western medicine (SMD = −1.02, 95% CI: −1.63 to −0.41, P < 0.00001) and CHM + Western medicine vs. Western medicine (SMD = −2.68, 95% CI: −4.36 to −1.00, P < 0.00001); (3) Lequesne severity index: CHM vs. Western medicine (SMD = −0.90, 95% CI: −1.40 to −0.39, P = 0.0005) and CHM + Western medicine vs. Western medicine (SMD = −0.94, 95% CI: −1.36 to −0.52, P < 0.0001); (4) Lysholm knee joint function score: CHM vs. Western medicine (MD = 9.10, 95% CI: 4.20 to 14.01, P = 0.0003), and CHM + Western medicine vs. Western medicine in a single trial (MD = 21.15, 95% CI: 19.71 to 22.59, P < 0.00001); (5) SOD: in a single trial, CHM vs. Western medicine (MD = 1.62, 95% CI: 0.9 to 2.30, P < 0.00001) and CHM + Western medicine vs. Western medicine (MD = 17.08, 95% CI: 10.71 to 23.44, P < 0.00001); (6) TNF-α: CHM vs. Western medicine (SMD = −1.90, 95% CI: −2.04 to −0.14, P = 0.02) and CHM + Western medicine vs. Western medicine (SMD = −2.32, 95% CI: −4.33 to −0.30, P = 0.02); (7) IL-1β: CHM vs. Western medicine (SMD = −1.60, 95% CI: −2.36 to −0.84, P < 0.0001); and (8) IL-6: in a single trial, CHM vs. Western medicine (MD = −0.75, 95% CI: −1.20 to −0.30, P = 0.001) and CHM + Western medicine vs. Western medicine (MD = −3.18, 95% CI: −6.24 to −0.12, P = 0.04). The efficacy of CHM in the treatment of K