Therapeutic efficacy of Xingnaojing injection for ischemic stroke: A systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract Background Stroke is one of the leading causes of human disability and death, and ischemic stroke constitutes 69.6–70.8% of all strokes. Xingnaojing injection (XNJ) is used to treat stroke in China, but its specific mechanism is not completely clear. This meta-analysis evaluated the clinical efficacy and safety of XNJ for ischemic stroke treatment and showed that XNJ could inhibit the inflammatory response of stroke patients. Methods Nine databases were searched from inception to 20 July 2021, following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) criteria for systematic reviews and meta-analyses. Two reviewers independently screened studies, extracted data of interest, and assessed the risk of bias. Meta-regression and subgroup analysis evaluated the heterogeneity and its impact on the results. Results In total, 24 separate RCTs, which were all conducted in China and published from 2008 to 2021, involved 2522 patients with ischemic stroke. XNJ combined with CT were better than CT alone in overall response rate (RR = 1.15, 95%CI [1.12, 1.19], p = 0.00), NIHSS score (WMD=-3.38, 95%CI [-4.35, -2.40], p = 0.00), Barthel index (WMD = 8.19, 95%CI [5.70, 10.68], p = 0.00), TNF-α (SMD=-2.75, 95%CI [-3.67, -1.84], p = 0.00), IL-6 (SMD=-2.56, 95%CI [-3.34, -1.70], p = 0.00), and CRP (SMD=-1.30, 95%CI [-1.58, -1.01], p = 0.00). Meta-analysis of safety showed that the data were not statistically significant (p = 0.21). For adverse events with low certainty evidence, safety needs further verification. Conclusions Based on the results, XNJ combined with CT likely improved clinical symptoms compared with CT alone. The mechanism may be related to the neuroprotective and anti-inflammatory effects. More high-quality, multicenter, and large-sample RCTs should be tested and verified in the future.