Objective:

2

To assess the effectiveness of Chinese herbal medicine (CHM) combined with adjuvant chemotherapy on myelosuppression for colorectal cancer (CRC) patients using network meta-analysis (NMA).

Methods:

2

Literature searches in both international (PubMed

Embase

Web of Science

and Cochrane Library) and Chinese (China Science and Technology Journal Database

Wanfang Data

China National Knowledge Infrastructure) databases for relevant randomized controlled trials (RCTs) were conducted from inception until October 10

2022. We included RCTs of patients who received CHM combined with chemotherapy

including FOLFOX

XELOX

FOLFIRI

and other relevant regimens in the CHM treatment group. The outcomes included the incidence of myelosuppression

leukopenia

hemoglobin reduction

and thrombocytopenia. Two reviewers independently screened the databases

extracted the data

and assessed the risk of bias and credibility of evidence. RevMan 5.4.1 software and STATA 14.0 were used to perform the NMA.

Results:

2

A total of 31 RCTs were included

published from 2008 to 2021 in Chinese. Among these

2

314 participants comparing the following 9 CHMs were identified: Shengbai Recipe (SBR)

Bazhen Decoction (BZD)

Jianpi Jiedu Recipe (JJR)

Jianpi Recipe (JR)

Compound Cantharis Capsule (CCC)

Zaofan Pill (ZFP)

Guilu Erxian Gel (GL)

Buzhong Tiaogan Decoction (BZ)

and Qiamagu Capsule (QM). The results of NMA found an indirect comparison. Based on the surface under the cumulative ranking curve (SUCRA)

the ZFP+ chemotherapy group had the lowest incidence of myelosuppression

with an odds ratio (OR) of 0.08 [95% confidence interval (CI): 0.01

0.76

]

whereas the GL+ chemotherapy group had the lowest incidence of leukopenia

hemoglobin reduction

and thrombocytopenia

with an OR of 5.25 (95% CI: 2.41

11.43)

4.66 (95% CI: 2.23

9.72)

and 0.27 (95% CI: 0.13

0.54)

respectively. Moreover

BZD + chemotherapy could alleviate leukopenia

hemoglobin reduction

and thrombocytopenia (

P

<

0.01). Pairwise comparison showed that there was no difference in the efficacy among the 8 CHMs+ chemotherapy group. The comparison and adjustment funnel plot indicated that small-study effect had no impact on these outcomes.

Conclusions:

2

This NMA provided evidence to support that patients with CRC benefit from receiving different combination of CHM chemotherapies. Among these

GL plus chemotherapy and BZD plus chemotherapy were the more effective for myelosuppression in patients; however

as the qualtiy of evidence is insufficient

further research is needed. (PROSPERO

No. CRD42022369025)