Clinical Efficacy of Traditional Chinese Medicine for COVID-19: A Systematic Review and Meta-Analysis

BACKGROUND: Traditional Chinese Medicine (TCM) has played crucial roles in treating COVID-19 in China. But its effectiveness has not been widely realized over the world. It is imperative to timely report the efficacy of TCM medicine in the treatment for COVID-19 based on the data from randomized controlled trials (RCTs) clinical studies. METHODS: We performed a systematic review and meta-analysis to investigate the clinical efficacy of TCM medicine in the treatment for COVID-19. We obtained the data for COVID-19 and Traditional Chinese Medicine from PubMed, Medline, Web of Science, medRxiv, bioRxiv, the Cochrane Central Register of Controlled Trials (CENTRAL), and China National Knowledge Infrastructure (CNKI). We searched these data sources from their inception to January 06, 2021, with no restriction by language, for the comparative clinical trial studies of treatment of COVID-19 with TCM medicinal formulae. We screened records, extracted data, and assessed risk of bias. We rated the certainty of evidences according to Cochrane methods in the meta-analyses. This study is registered with PROSPERO, CRD42020205856. FINDINGS: Our search identified 20 RCT studies in different cities across China (n= 1949 patients). The treatment of COVID-19 by TCM combined with conventional treatment is more effective than by the conventional treatment alone shown from many aspects, including increasing of the effective rate [OR=2.48, 95%CI (1.85, 3.32), P<0.00001], fever disappearance rate [OR=3.68, 95%CI (1.95, 6.96), P<0.0001], fatigue disappearance rate [OR = 3.15, 95%CI (1.60, 6.21), P=0.0009], cough disappearance rate [OR = 3.54, 95%CI (2.12, 5.90), P <0.0001], expectoration disappearance rate [OR = 5.94, 95%CI (1.98, 17.84), P =0.001], disappearance rate of shortness of breath [OR = 3.77, 95%CI (1.18, 12.01), P=0.02], improvement rate of CT image [OR = 2.43, 95%CI (1.86, 3.16), P<0.00001], white blood cells count [MD = 0.46, 95%CI (0.20, 0.72), P=0.0006], lymphocyte count [MD = 0.34, 95%CI (0.05, 0.62), P=0.02]; and reduction of the hospitalization time [MD=-4.47, 95%CI (-6.15, -2.79), P<0.00001], fever disappearance time [MD = -1.84, 95%CI (-2.42, -1.25), P<0.00001], fatigue disappearance time [MD = -2.15, 95%CI (-2.58, -1.73), P<0.00001], TCM Syndrome Scale score [SMD=-0.75, 95%CI (-1.18, -0.33), P =0.0006], and deterioration rate [OR=0.47, 95%CI (0.28, 0.78), P = 0.004]. INTERPRETATION: The findings of this meta-analysis suggest that TCM can effectively relieve symptoms, boosted patients' recovery, cut the rate of patients developing into severe conditions, and reduced the mortality rate. The advantages of the TCM medicine are effective, cheap, and personalized; particularly it can be promptly refined according to the change of pandemic pattern. Although more robust randomized trials are still needed to better inform the efficacy of TCM medicine, this systematic appraisal of currently best available evidence might inform interim guidance for understanding the effectiveness of TCM in treating COVID-19.