Key Takeaways & Executive Findings
- •• Xingnaojing injection demonstrated the highest probability of improving neurological function in ischemic stroke patients, with a SUCRA value of 0.85. • All evaluated TCM injections had comparable safety profiles, with no significant increase in adverse events compared to conventional therapy. • Cost-effectiveness analysis favored Xingnaojing injection as the most cost-effective option in the Chinese healthcare context. • The findings support the use of TCM injections as adjunctive therapy for ischemic stroke, but highlight the need for more rigorous, large-scale trials.
Abstract
Background: Ischemic stroke is a leading cause of disability and mortality worldwide. Traditional Chinese Medicine (TCM) injections are widely used in China as adjunctive therapy, but comparative evidence is lacking. This network meta-analysis aimed to evaluate the safety, effectiveness, and cost-effectiveness of different TCM injections for ischemic stroke. Methods: We systematically searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases up to October 2024. Randomized controlled trials (RCTs) comparing TCM injections (e.g., Xingnaojing, Shenmai, Danhong, etc.) with conventional treatment or placebo were included. A Bayesian network meta-analysis was performed to compare outcomes including neurological function improvement (NIHSS score), adverse events, and cost-effectiveness. Results: A total of 45 RCTs involving 4,320 patients were included. Xingnaojing injection showed the highest probability of improving neurological function (SUCRA=0.85), followed by Danhong (0.78) and Shenmai (0.72). All TCM injections had similar safety profiles, with no significant differences in adverse events. Cost-effectiveness analysis indicated that Xingnaojing was the most cost-effective option in the Chinese healthcare setting. Conclusion: TCM injections, particularly Xingnaojing, may offer additional benefits in neurological recovery without increasing adverse events, and are cost-effective in China. However, due to heterogeneity and potential publication bias, further high-quality trials are warranted.
1. Introduction
Ischemic stroke remains a major global health burden, being a leading cause of long-term disability and mortality. In China, Traditional Chinese Medicine (TCM) injections are extensively used as adjunctive therapy for stroke, based on the theory of promoting blood circulation and removing blood stasis. However, the comparative efficacy and safety among various TCM injections have not been systematically evaluated, leading to uncertainty in clinical decision-making.
This network meta-analysis was conducted to synthesize evidence from randomized controlled trials, comparing the effectiveness, safety, and cost-effectiveness of commonly used TCM injections (e.g., Xingnaojing, Shenmai, Danhong, etc.) in the treatment of ischemic stroke. The aim is to provide a comprehensive evidence base to guide clinicians and policymakers in selecting the most appropriate TCM injection, balancing clinical benefits and economic considerations.
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Xing Wang, Gang Chen, ... (2026). Comparative Analysis of Safety, Effectiveness, and Cost-Effectiveness of Traditional Chinese Medicine Injections in the Treatment of Ischemic Stroke: A Network Meta-Analysis. Chinese Journal of New Drugs. https://doi.org/10.1007/s12325-024-02945-6
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Frequently Asked Questions
What is the most effective Traditional Chinese Medicine injection for ischemic stroke?
According to this network meta-analysis, Xingnaojing injection showed the highest probability of improving neurological function, with a SUCRA value of 0.85, making it the most effective among the evaluated TCM injections.
Are Traditional Chinese Medicine injections safe for ischemic stroke patients?
Yes, the analysis found that all evaluated TCM injections had comparable safety profiles, with no significant increase in adverse events compared to conventional therapy, indicating they are generally safe when used appropriately.
Which TCM injection is the most cost-effective for ischemic stroke treatment in China?
The cost-effectiveness analysis favored Xingnaojing injection as the most cost-effective option in the Chinese healthcare setting, considering both clinical outcomes and healthcare costs.
What is the clinical significance of this network meta-analysis?
This study provides a comprehensive comparative evidence base for TCM injections in ischemic stroke, helping clinicians choose the most effective and cost-effective treatment, and highlighting the need for further high-quality trials to confirm these findings.
What are the limitations of this study?
The study acknowledges limitations including heterogeneity among included trials, potential publication bias, and the lack of long-term outcome data, which may affect the robustness of the conclusions.
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