COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Luo X, Ni X, Lin J, et al. The add-on effect of Chinese herbal medicine on COVID-19: A systematic review and meta-analysis. Phytomedicine. 2020 Jul 11:153282. doi: 10.1016/j.phymed.2020.153282.

BACKGROUND: Chinese herbal medicine (CHM) is thought to be a potential intervention in the treatment of coronavirus disease (COVID-19).

PURPOSE: This study aimed to investigate the efficacy and safety of CHM or CHM combination therapy for COVID-19.

STUDY DESIGN: Systematic review and meta-analysis METHODS: We searched for relevant studies in the CNKI, CBM, Wanfang Data, PubMed, Cochrane Library, Embase, and other resources from their inception to April 15, 2020. Randomized controlled trials, cohort studies, and case-control studies on CHM or CHM combination therapy for COVID-19 were included. Meta-analysis was performed according to the Cochrane Handbook.

RESULTS: Overall, 19 studies with 1474 patients were included. Meta-analysis showed that the overall clinical effectiveness (OR = 2.67, 95% CI 1.83-3.89, I2 = 0%), improvement in the CT scan (OR = 2.43, 95% CI 1.80-3.29, I2 = 0%), percentage of cases turning to severe/critical (OR = 0.40, 95% CI 0.24-0.67, I2 = 17.1%), reverse transcription-polymerase chain reaction (RT-PCR) negativity rate (OR = 2.55, 95% CI 1.06-6.17, I2 = 56.4%) and disappearance rate of symptoms (fever, cough, and fatigue) were superior by combined CHM treatment of COVID-19. However, there was no statistical difference between the two groups in terms of length of hospital stay (WMD = -0.46, 95% CI -3.87 - 2.95, I2 = 99.5%), and rate of adverse effects (OR = 1.21, 95% CI 0.48-3.07, I2 = 43.5%). The quality of evidence was very low to low.

CONCLUSION: The combined treatment of COVID-19 with Chinese and Western medicine may be effective in controlling symptoms and reducing the rate of disease progression due to low quality evidence.

Discipline / Specialty Area Score
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Intensivist/Critical Care
Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

The Chinese medicines used are many and varied. The quality of evidence from the many studies is low, so I am not sure how this can be usefully integrated into clinical care in other environments. More research is definitely required to clarify this.

General Internal Medicine-Primary Care(US) rater

Several statements which are internally contradictory. Symptoms and rate of progression (combo CHM and western) were reduced but the outcomes were unchanged. The study is already outdated. Metaanalysis always risks losing patient-level observations. We are STILL missing entire UNKNOWN dimensions in this entire disease-syndrome and phenomenon. My clinical and intellectual bias are summarized in Disraeli-Twain statistics.

Hospital Doctor/Hospitalists rater

This is a systematic review and meta-analysis. It considered randomized controlled trials, cohort studies, case control studies, unclear binding of participants, personal, outcome, and allocation concealment. They use the PRISMA checklist, the GRADE approach, and their result with low heterogeneity. This Meta-analysis showed overall effectiveness with combined CHM (Chinese herbal medicine) with routine (?) and diverse other treatments, but not in terms of hospital stay, adverse effects or mortality. They don’t mention time to control symptoms nor days to have a RT-PCR negative test, (natural evolution?), but fewer patients develops severe symptoms. In this case with so little treatment options, if CHM can control symptoms, even with a low quality of evidence, they can continue to be used, and since the Chinese prefer this type of treatments, they will probably be frequently used.

Infectious Disease rater

The content of the paper is well researched and analyzed, but the conclusions overstep; the role of TCM is hardly established here, and, if anything, this shows a lack of benefit for most situations in their analysis. The conclusion reads as if this is a positive study; I read the results as a negative one.

Intensivist/Critical Care rater

This is a well performed systematic review and metaanalysis examining the add on benefit of Chinese herbal medicine in the treatment of patients with COVID-19. Overall, there was a possible benefit with regards to disease progression and symptom treatment. Although not definitive, the conclusions support possible use in selected cases and further controlled research with specific agents and indications.