Table 1.
Summary of the included systematic review of CAM for COVID-19
| Author (year) [ref] | Review objectives (quoted) | No. included studies | Intervention | Comparator | Main Outcomes | Direction of effect | Overall risk of bias (quoted) | Overall confidence (AMSTAR2) | Conclusion (quoted) |
|---|---|---|---|---|---|---|---|---|---|
| TCM | |||||||||
| Ang 202010 | “… to evaluate the effectiveness and adverse events of herbal medicines for the treatment of COVID-19” | 7 RCTs | HM plus WM | WM | 1) Effective rate 2) Hospital discharge rate 3) Symptom disappearance rate |
1), 2) + 3) cough: +; sputum: + |
Unclear | Moderate | “… the combined therapy of herbal medicine with Western medicine … revealed the potential role of herbal medicine in treating COVID-19” |
| Du 202111 | “… to evaluate the add-on effect of CHM in the treatment of mild to moderate COVID-19” | 12 RCTs | CHM plus WM | WM | 1) CT recovery rate 2) Effective rate |
1), 2) + |
Unclear | High | “CHM combined with conventional therapy may be effective and safe in the treatment of mild to moderate COVID-19” |
| Fan 202012 | “… summarized … CHM to treat COVID-19” | 7 RCTs | CHM | Standard care (WM or routine medical care) | 1) Symptom improvement score 2) CRP 3) CT recovery rate |
1)–3) + |
Unclear | High | “… CHM, as an adjunct treatment with standard care, … improve treatment outcomes in COVID-19 …” |
| Hu 202013 | “… to provide reliable assessments of …COVID-19 pneumonia” | 42 RCTs | LQ or LQ plus WM | WM (antibiotics, antiviral drugs) | 1) Flu-Like symptoms 2) Cure rate |
1), 2) + |
Unclear | Moderate | “Lianhua Qingwen combined with conventional drugs may be a promising therapy for treating … COVID-19 pneumonia” |
| Jiang 202114 | “… provides … efficacy … of treating COVID-19 with combined TCM and WM” | 19 RCTs and 16 OS | TCM (CHM and CPM) or TCM plus WM | WM | 1) Effective rate 2) Disease progression rate 3) VNA negative conversion rate |
1), 2) + 3) +/– |
Low | High | “TCM combined with CWM was a potential treatment option for … COVID-19 patients” |
| Li 202115 | “… to evaluate the supportive effects of …TCM for the treatment of COVID-19” | 8 studies | CHM plus WM | WM | 1) Effective rate 2) CT recovery rate 3) Aggravation or hospitalization |
1)–3) + |
NOS (score 4: 6studies; score 5: 1 study); Jadad (score 6: 1 study) | Moderate | “… TCM with Western medicine has significantly improved … COVID-19 …” |
| Liang 202016 | “To present the … therapeutic effects … of CHM … for COVID-19” | 10 RCTs, 1 NRS, 11 RS, 12 CS and 24 CR | CHM | WM or placebo | 1) Cure rate 2) Mortality rate 3) Aggravation rate |
1) +/- 2) + 3) +/– |
Low | Moderate | “… CHM plus conventional western therapy is superior to conventional western therapy alone” |
| Liang 202117 | “… to evaluate the therapeutic effects and safety of oral Chinese patent medicine for COVID-19” | 7 RCTs | CHM or CHM plus WM | WM | 1) Cure rate 2) Mortality rate 3) Aggravation rate |
1), 2) + 3) +/– |
low-certainty or very low-certainty | High | “… oral Chinese patent medicine may have …therapeutic effects for patients with non-serious COVID-19” |
| Liu 202018 | “… to assess the efficacy and safety of …Integrated Medicine to COVID-19” | 4 RCTs, 7CCS | CHM | WM | 1) Effective rate 2) Hospital stays |
1), 2) + |
Low | Moderate | “… Integrated Medicine had better effects … for COVID-19” |
| Liu 2021a19 | “… to assess the efficacy and safety of LQ in treating patients with COVID-19 …” | 3 RCTs, 3 CCS, 2 CS | LQ | WM | 1) Effective rate 2) CT recovery rate 3) Aggravation rate |
1)–3) + |
Low | Moderate | “Lianhuaqingwen combined with conventional treatment seems to be …effective for … mild or ordinary COVID-19” |
| Luo 202120 | “… to investigate the efficacy and safety of CHM or CHM combination therapy for COVID-19” | 19 (6 RCTs, 13 CCS) | CHMor CHM plus other treatments | Placebo or other therapy | 1) Effective rate 2) CT recovery rate 3) RT-PCR negative rate |
1)–3) + |
Unclear | High | “The combined treatment of COVID-19 with Chinese and Western medicine may be effective …” |
| Pang 202021 | “… to evaluate the efficacy and safety of CMD for COVID-19” | 11 RCTs | CHM | WM | 1) The rate of clinical change to sever or critical condition 2) All-cause death |
1) + 2) +/– |
Unclear | Moderate | “CMD may bring potential benefit to … COVID-19. ” |
| Shi 202122 | “… testing the efficacy of CHM on … COVID-19…” | 19 RCTs and 29 OS | CHM plus drug therapy | Drug therapy or drug therapy plus placebo | 1) Remission rate 2) Effective rate of returned normal level |
1) Nausea: +/–; anorexia: +; diarrhea: +/– 2) ALT: +/–; AST: +/– |
Unclear (RCT), High (OS) | High | “… CHM had some benefits in …of COVID-19 …” |
| Sun 202023 | “…to evaluate … Chinese medicine in the treatment of COVID-19 pneumonia” |
7 RCTs | CHM | WM | 1) Effective rate 2) VNA negative conversion rate 3) CT recovery rate |
1) + 2) +/– 3) + |
Unclear | Moderate | “… Chinese medicine has demonstrated clinical efficacy and safety on COVID-19 …” |
| Wang 2021a24 | “To evaluate …three medicines and three formulations… for COVID-19” | 13 studies (6 RCTs, 7 RS) | CHM | Usual care | Time to resolution of fever | + |
Low | High | “…three medicines and three formulations, … on top of usual care, may offer some relief for …mild or moderate COVID-19 …” |
| Wang 2021b25 | “… to summarize the latest evidence of TCM in COVID-19” | 7 RCTs | CHM or CHM plus other treatments | Placebo, WM, and usual care | 1) Cure rate 2) VNA negative conversion rate |
1) + 2) +/– |
Some concerns | Moderate | “… TCM plus routine treatment could promote a clinical cure …in patients with COVID-19” |
| Xiong 202026 | “… to evaluate …CHM for … COVID-19” | 11 RCTs | CHM | WM | 1) CT recovery rate 2) Clinical cure rate 3) Length of hospital stay |
1) + 2), 3) +/– |
Unclear | High | “… CHM group has improvements in several clinical parameters including lung CT” |
| Yan 202127 | “To explore the clinical efficacy of the combination of TCM and WM…for …COVID-19” | 9 RCTs | CHM and WM | WM | 1) Rate of progression to severe stage 2) Cure rate 3) Mortality rate |
1), 2) + 3) +/– |
Low | Moderate | “A combined treatment strategy is effective for COVID-19” |
| Zeng 202028 | “… LQ in the treatment of …COVID-19…” | 2 RCTs | LQ plus WM | WM | Disappearance rate |
Cardinal clinical symptoms: +/–; fever duration: + | Low | High | “… TCM … can be used as an effective therapy to improve …” |
| Zhou 202129 | “… to assess the effects of TCM … for COVID-19 …” | 10 RCTs | CHM | WM | 1) Cure rate 2) Relief rate |
1) + 2) fever: +/–; cough: + |
Unclear | Moderate | “TCM may be an effective auxiliary treatment for COVID-19 …” |
| Zhuang 202130 | “…evaluate the clinical efficacy of LQ on … COVID-19” | 1 RCT and 2RS | LQ granules or capsules | Symptomatic, nutritional support, antiviral and antibacterial, and other routine treatment | 1) The rate of clinical change to sever or critical condition 2) Fever duration 3) disappearance rate of fever |
1)–3) + |
Unclear | Moderate | “…Lianhua Qingwen on the treatment of COVID-19 has significant efficacy …” |
| Home based activities | |||||||||
| Puyat 202031 | “… home-based activities …were examined” | 16 RCTs | Exercise, yoga, and etc | No restrictions were placed on study comparators | Mental health outcomes | + | High | Moderate | “…home-based activities can promote mental wellness during the COVID-19 pandemic” |
| Vitamin D | |||||||||
| Bassatne 202132 | “… assesses the impact of vitamin D status … on COVID-19 …” | 3 RCTs and 31 OS | High serum vitamin D | Low serum vitamin D level | 1) Mortality rate 2) ICU admission rate 3) Hospitalization rate 4) Length of hospital stay |
1)–4) +/– | Unclear | High | “… none of the outcomes ... revealed …cause effect relationship of vitamin D status on COVID-19 …” |
| Rawat 202133 | “… to assess the impact of Vitamin-D … in …COVID-19” | 3 RCTs and 2 QES | Vitamin D plus standard therapy | No vitamin D | 1) Mortality rate 2) ICU admission rate |
1), 2) +/– | Low | Moderate | “No significant difference with vitamin-D supplementation on major health related outcomes in COVID-19” |
All the studies did not mention the publication bias.
ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CAM: complementary and alternative medicine; CCS: case control studies; CHM: Chinese herbal medicine; CI: confidence interval; COVID-19: Coronavirus disease 2019; CPM: Chinese patent medicine; CR: case reports; CRP: C-reactive protein; CS: case studies; CT: computed tomography; HM: herbal medicine; ICU: Intensive care unit; LQ: Lianhua Qingwen; NOS: Newcastle–Ottawa Scale; NRS: non-randomized studies; OR: odds ratio; OS: observational studies; QES: quasi experimental studies; RCT: randomized controlled trial; RT-PCR: Reverse Transcription Polymerase Chain Reaction; RR: risk ratio; RS: retrospective studies; TCM: traditional Chinese Medicine; VNA: Viral nucleic acid; WM: Western medicine; WMD: weighted mean difference; +: favorable to intervention; +/–: no difference.