Chinese Herbal Medicines Compared with N-Acetylcysteine for the Treatment of Idiopathic Pulmonary Fibrosis: A Systematic Review of Randomized Controlled Trials

Table 4

Summary of finding table: Chinese Herbal Medicines compared to N- acetylcysteine for IPF.

CHMs + NAC vs. NAC
Patient or population: [Patients with Idiopathic pulmonary fibrosis]
Setting: inpatients or outpatients
Intervention: [Chinese herbal medicines+ N-acetylcysteine]
Comparison: [N-acetylcysteine]
Outcome	No. of participants (studies)	Relative effect (95% CI)	Anticipated absolute effects (95% CI)		Quality of the evidence; (GRADE)
			NAC	CHMs + NAC
AE-IPF	34; (1 RCT)	RR 0.44; (0.04 to 4.45)	-	-	⨁⨁◯◯; low
Morality	34; (1 RCT)	RR 0.30; (0.01 to 6.84)	-	-	⨁◯◯◯; very low
SGRQ; (6months)	60; (1 RCT)	-	The mean SGRQ(6months) was 0	MD 3.48 lower; (6.86 lower to 0.1 lower)	⨁⨁◯◯; low
6MWT; (6months)	60; (1 RCT)	-	The mean 6MWT(6months) was 0	MD 16.93 higher; (0.45 higher to 33.41 higher)	⨁⨁◯◯; low
CHMs vs. NAC
Patient or population: [Patients with Idiopathic pulmonary fibrosis]
Setting: inpatients or outpatients
Intervention: [Chinese herbal medicines]
Comparison: [N-acetylcysteine]
Outcome	No. of participant; (studies)	Relative effect; (95% CI)	Anticipated absolute effects (95% CI)		Quality of the evidence; (GRADE)
			NAC	CHMs
SGRQ	145; (3 RCTs)	-	The mean SGRQ was 0	MD 10.87 lower; (14.3 lower to 7.44 lower)	⨁⨁⨁◯; moderate
6MWT	171; (4 RCTs)	-	The mean 6MWT was 0	MD 30 higher; (26.22 higher to 33.77 higher)	⨁⨁⨁◯; moderate
CHMs + CM vs. NAC + CM
Patient or population: [Patients with Idiopathic pulmonary fibrosis]
Setting: inpatients or outpatients
Intervention: [CHMs + CM]
Comparison: [NAC + CM]
Outcome	No. of participant; (studies)	Relative effect; (95% CI)	Anticipated absolute effects (95% CI)		Quality of the evidence; (GRADE)
			NAC + CM	CHMs + CM
SGRQ	40; (1 RCT)	-	The mean SGRQ was 0	MD 4.36 lower; (18.5 lower to 9.78 higher)	⨁◯◯◯; very low
6MWT	147; (3 RCTs)	-	The mean 6MWT was 0	MD 85.32 higher; (56.16 higher to 114.49 higher)	⨁◯◯◯; very low
CHMs + NAC + CM vs. NAC + CM
Patient or population: [Patients with Idiopathic pulmonary fibrosis]
Setting: inpatients or outpatients
Intervention: [CHMs + NAC + CM]
Comparison: [NAC + CM]
Outcome	No. of participant; (studies)	Relative effect; (95% CI)	Anticipated absolute effects (95% CI)		Quality of the evidence; (GRADE)
			NAC + CM	CHMs + NAC + CM
SGRQ	50; (1 RCT)	-	The mean SGRQ was 0	MD 13.11 lower; (25.46 lower to 0.76 lower)	⨁⨁◯◯; low
6MWT	50; (1 RCT)	-	The mean 6MWT was 0	MD 109.22 higher; (12.41 higher to 206.03 higher)	⨁⨁◯◯; low
The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio; MD: Mean difference
GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Explanations
a. No blinding.
b. High heterogeneity.
c. Wide effect interval.
d. P<0.1 in Egger’s test.