Chinese Medicine for Coronavirus Disease 2019 (COVID-19): An Updated and GRADE-Assessed Systematic Review and Meta-Analysis

Coronavirus disease 2019 (COVID-19) is a huge ongoing public health concern globally. This study aims to update the evidence for Chinese medicine (CM) against COVID-19. Eleven databases were searched on June 30, 2021. An initial search of 4180 studies was conducted and the final number of included studies remained at 52. The statistical methods and analysis of the combined results remained unchanged. The RoB 2.0, ROBINS-I and GRADE tools continued to be used to assess risk and level of evidence. The findings with the moderate certainty in GRADE showed that compared with routine treatment (RT), Lianhua Qingwen granules (LHQW) adjunctive to RT showed a significantly improved efficacy rate (Relative risk (RR) = 1.19, 95% confidence interval (CI) [1.09, 1.31]), febrile score (standard mean difference (SMD) = - 1.21, 95% CI [- 1.43, -0.99]), and computerized tomography (CT) lung images (RR= 1.23, 95% CI [1.10, 1.38]); Qingfei Paidu decoction (QFPD) plus RT significantly shortened the length of hospital stay (SMD = - 1.83, 95% CI [- 2.18, - 1.48]); Feiyan Yihao formula (FYYH) plus RT significantly improved the clinical efficacy rate (RR= 1.07, 95% CI [1.00, 1.15]), and time to negative PCR test for COVID-19 (SMD = - 0.72, 95% CI [- 0.94, - 0.51]). Adjunctive effects of CM with lower certainty of evidence were found, including improvements in symptoms, laboratory outcomes and mortality. No adverse events or minor adverse events were observed in the majority of studies. In conclusion, the current evidence remains unchanged that CM formulations, particularly LHQW, QFPD and FYYH, have an adjuvant effect on standard treatment of COVID-19.