COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

COVID-19 Evidence Alerts needs your support. If our service is of value to you, please consider donating to keep it going. Learn more Donate now

Treatment Shi S, Wang F, Li J, et al. The effect of Chinese herbal medicine on digestive system and liver functions should not be neglected in COVID-19: An updated systematic review and meta-analysis. IUBMB Life. 2021 May;73(5):739-760. doi: 10.1002/iub.2467. Epub 2021 Apr 2.

Gastrointestinal symptoms and liver injury are common in patients with coronavirus disease 2019 (COVID-19). However, profiles of different pharmaceutical interventions used are relatively underexplored. Chinese herbal medicine (CHM) has been increasingly used for patients with COVID-19, but the efficacy of CHM used in COVID-19 on gastrointestinal symptoms and liver functions has not been well studied with definitive results based on the updated studies. The present study aimed at testing the efficacy of CHM on digestive symptoms and liver function (primary outcomes), the aggravation of COVID-19, and the time to viral assay conversion (secondary outcomes), among patients with COVID-19, compared with standard pharmacotherapy. The literature search was undertaken in 11 electronic databases from December 1, 2019 up to November 8, 2020. Appraisal of the evidence was conducted with Cochrane risk of bias tool or Newcastle Ottawa Scale. A random-effects model or subgroup analysis was conducted when significant heterogeneity was identified in the meta-analysis. The certainty of the evidence was assessed with the grading of recommendations assessment, development, and evaluation approach. Forty-eight included trials involving 4,704 participants were included. Meta-analyses favored CHM plus standard pharmacotherapy for COVID-19 on reducing the aggravation of COVID-19 and the time to viral assay conversion compared with standard pharmacotherapy. However, the present CHM as a complementary therapy for treating COVID-19 may not be beneficial for improving most gastrointestinal symptoms and liver function based on the current evidence. More well-conducted trials are warranted to confirm the potential efficacy of CHM furtherly.

Discipline / Specialty Area Score
Infectious Disease
Intensivist/Critical Care
Comments from MORE raters

Infectious Disease rater

A thoughtful review of clinical studies of Chinese herbal remedies. ~4,000 total patients were included and the "liver" test results and intestinal symptoms in COVID-19 infection concludes that Chinese herbal remedies "... may not be beneficial for improving most gastrointestinal symptoms and liver function based on the current evidence."