Still awaiting evidence on Chinese medicinal herbs for chronic hepatitis B

Chronic hepatitis B is an infectious disease of the liver caused by hepatitis B virus. Around 350 million people worldwide are chronic infected carriers of the virus. Traditional Chinese medicinal herbs have for long been used for treating chronic liver diseases both in China and in Southeast Asia. This systematic review evaluates the effect of Chinese medicinal herbs (single or compound) for treating chronic hepatitis B infection.

The review of trials found that some of the Chinese medicinal herbs may have a positive effect on the clearance of hepatitis B virus and on the diseased liver. However, the methodological quality of the trials evaluating these herbs was generally poor. Analysis of the identified trials also indicated that trials with positive findings are more likely to be published than trials without significant findings. Further, medicinal herbs may be associated with side effects. Therefore, Chinese medicinal herbs should not be used outside new trials. Testing the herbs in larger, well-designed trials is needed in order to establish the necessary evidence for their use.

Authors' conclusions: 

Some Chinese medicinal herbs may work in chronic hepatitis B. However, the evidence is too weak to recommend any single herb. Rigorously designed, randomised, double-blind, placebo-controlled trials are required.

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Background: 

Hepatitis B virus infection is a serious health problem worldwide. Traditional Chinese medicinal herbs have been widely used to treat chronic liver diseases, and many controlled trials have been done to investigate their efficacy.

Objectives: 

To assess the efficacy and safety of traditional Chinese medicinal herbs for chronic hepatitis B infection.

Search strategy: 

Searches were applied to the following electronic databases: the Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Complementary Medicine Field Trials Register, The Cochrane Library (Issue 2, 2000), MEDLINE, EMBASE, and BIOSIS (October 2000). Five Chinese journals and conference proceedings were handsearched. No language restriction was used.

Selection criteria: 

Randomised or quasi-randomised trials with at least three months follow-up. Trials of Chinese medicinal herbs (single or compound) compared with placebo, no intervention, general non-specific treatment or interferon treatment were included. Trials of Chinese medicinal herbs plus interferon versus interferon alone were also included. Trials could be double-blind, single-blind, or unblinded.

Data collection and analysis: 

Data were extracted independently by two reviewers. The methodological quality of trials was evaluated using the Jadad-scale plus allocation concealment. Intention-to-treat analyses were performed.

Main results: 

Nine randomised trials, including 936 patients, met the inclusion criteria. Methodological quality was considered adequate in only one trial. There was a significant funnel plot asymmetry (regression coefficient=3.37, standard error 1.40, P=0.047).

Ten different medicinal herbs were tested in the nine trials. Compared to non-specific treatment or placebo, Fuzheng Jiedu Tang (compound of herbs) showed significantly positive effects on clearance of serum HBsAg, HBeAg, and HBV DNA; Polyporus umbellatus polysaccharide on serum HBeAg and HBV DNA; Phyllanthus amarus on serum HBeAg. Phyllanthus compound and kurorinone showed no significant effect on clearance of serum HBeAg and HBV DNA and on alanine aminotransferase normalisation compared to interferon treatment. There were no significant effects of the other examined herbs.

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