Puerarin for acute ischaemic stroke

Review question

To assess the effects of puerarin in people with ischaemic stroke.

Background

Stroke is a common cause of death and serious disability. Puerarin, a type of Chinese traditional medicine extracted from the root of Pueraria lobata (Willd.), commonly known as kudzu, is widely used in the treatment of acute ischaemic stroke in China. Previous studies implied potent antioxidation properties and neural protective effects, but whether current evidence provides support for recommending puerarin for routine use is still uncertain.

Study characteristics

We searched for trials up to August 2015 and included 20 randomised controlled trials involving 1574 participants, of puerarin for people with ischaemic stroke. Only two trials reported death or dependency at the end of follow-up. The remaining studies followed participants for less than one month.

Key results

We included 20 RCTs with 1574 participants in this updated review; five trials were new. Treatment with puerarin did not reduce death or dependency at final follow-up. Puerain improved neurological deficit at the end of treatment. The included trials did not report serious adverse effects.

Quality of the evidence

The quality of evidence was low due to incomplete reporting of the methods and short-term follow-up.

Authors' conclusions: 

There is not enough evidence to evaluate the effect of puerarin on survival or dependency in people with ischaemic stroke. High quality and large-scale RCTs with long-term follow-up are needed to assess its efficacy.

Read the full abstract...
Background: 

Puerarin, a form of herbal medicine, is widely used in the treatment of ischaemic stroke in China.

Objectives: 

To assess the effects of puerarin in people with ischaemic stroke.

Search strategy: 

We searched the Cochrane Stroke Group Trials Register and the Chinese Stroke Trials Register (last searched August 2015). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 7), MEDLINE (1948 to August 2015), EMBASE (1980 to August 2015), AMED (the Allied and Complementary Medicine Database, 1985 to August 2015) and the China Biological Medicine Database (CBM-disc 1979 to August 2015). We searched reference lists, relevant clinical trials and research registers and contacted pharmaceutical companies and researchers in an effort to identify further published and unpublished studies.

Selection criteria: 

Randomised controlled trials (RCTs) or quasi-randomised controlled clinical trials comparing puerarin with placebo or open control (no placebo) in people with ischaemic stroke.

Data collection and analysis: 

Two review authors independently applied the inclusion criteria, assessed trial quality and risk of bias, and extracted the data.

Main results: 

We included 20 RCTs with 1574 participants in this updated review. All trials were published in Chinese language journals. We included 14 trials that we had excluded in the previous version of the review after we added a new outcome in this update. Time windows within which the participants were randomised ranged from 4.5 hours to 10 days. Ischaemic stroke was confirmed by computerised tomography (CT) or magnetic resonance imaging (MRI) in 18 trials. Meta-analysis of two trials with 164 participants showed that treatment with puerarin did not reduce death or dependency at final follow-up (RR 0.79, 95% CI 0.45 to 1.36). One trial with 83 participants reported that the mean value of the Barthel Index in the puerarin group was below that in the control group. Meta-analysis of 16 trials with 1305 participants showed that puerarin reduced the proportion of participants without improvement of neurological deficit at the end of follow-up (RR 0.42, 95% CI 0.33 to 0.55). None of the included trials reported serious adverse effects.The quality of evidence was low due to incomplete reporting of the methods and short-term follow-up.

Share/Save