The efficacy and safety of traditional Chinese medicine Guilu Erxian Jiao in the treatment of knee osteoarthritis: A systematic review and meta-analysis

A systematic review was conducted to investigate the efficacy of Guilu Erxian Jiao (GEJ) in the treatment of knee osteoarthritis (OA).We searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Electronic Periodical Services, and ClinicalTrials.gov to identify relevant randomized controlled trials or controlled clinical trials, from the inception of each source to April 20, 2021. Primary outcome included overall efficacy, pain score, and Lequesne index score; secondary outcome included adverse events. Methodological quality was assessed using the Cochrane risk of bias tool (RoB 1.0). The meta-analysis was performed based on a random-effects model due to anticipated clinical heterogeneity. The grading of overall evidence was assessed using the GRADE system. The study protocol was registered on PROSPERO (CRD42021233573).Eight studies were included. Compared to controls, GEJ exhibited superior overall efficacy for treating OA (risk ratio (RR) = 1.20; 95% confidence interval (CI) = 1.06-1.35). Regarding pain score, there was no statistical difference between GEJ and controls (standardized mean difference (SMD) = 0.27; 95% CI = -0.91 - 1.46). No significant difference was found in Lequesne score between GEJ and controls (MD = -0.25; 95% CI = -0.52 - 0.01). No statistical difference in adverse reactions was observed between GEJ and controls (risk difference (RD) = -0.01; 95% CI = -0.05-0.03).Our findings suggest that GEJ may have positive effects on overall efficacy in treating OA. However, there is insufficient evidence regarding pain score, Lequesne score, and knee joint function score.