Efficacy and safety of Chinese herbal medicine longdanxiegan decoction combined with val-acyclovir in herpes zoster: A systematic review and mate-analysis

Background: Herpes zoster is a global public problem that is characterised by a painful blistering rash and unilateral lesions and has a significant negative impact on the quality of patients’ lives. Longdanxiegan Decoction (LDXGD) is a classic herbal formula, and LDXGD combined with valacyclovir is widely used for herpes zoster patients in China. However, evidence-based medicine is not available. Therefore, it is necessary to systematically evaluate the effectiveness of LDXGD combined with valacyclovir in the treatment of herpes zoster, which will provide theoretical support for the treatment of herpes zoster. Objective: This systematic review aimed to explore the effectiveness of LDXGD combined with val-acyclovir for herpes zoster and to compare LDXGD combined with val-acyclovir and val-acyclovir alone. Methods: PubMed, Chinese Scientific Journals Database (VIP), China National Knowledge Infrastructure (CNKI), and Wan-fang Database were searched up to 6 April 2021. Randomised Controlled Trials (RCTs) were identified for herpes zoster treatment involving LDXGD combined with val-acyclovir. The quality of the literature was evaluated using the Cochrane assessment tool to reduce the risk of bias. RevMan 5.4.1 software was used to perform the meta-analysis. Results: Five studies involving 414 participants were identified in this systematic review. Studies were of low to moderate methodological quality based on the risk of bias assessment. The results of our meta-analysis showed the relative benefits of LDXGD combined with valacyclovir in effective rates compared with valacyclovir alone (four studies; P=0.97, I2=0%, OR=4.48, 95%CI [1.89,10.67]), pain intensity (visual analogue scale) (MD: -1.40 mm; 95% CI [-1.89 to -0.92]), The incidence of PHN (RR 0.24; 95% CI [0.10, 0.55]; I2 =0%) and time to crust formation (MD= -1.66 days; 95% CI [2.01,1.30]). The safety of LDXGD combined with valacyclovir remains unclear. Conclusion: Our systematic evaluation provides evidence for the clinical effectiveness and safety of LDXGD combined with valacyclovir for the treatment of herpes zoster. Further trials are necessary to collect evidence for the use of LDXGD. Keywords: Herpes zoster; Longdanxiegan decoction; Valacyclovir; Systematic review; Randomized control trial.