TCM formulas for strengthening the spleen, tonifying Qi, and supplementing the marrow in the treatment of MG: A network meta-analysis

Myasthenia gravis (MG) is an autoimmune disease that primarily affects the acetylcholine receptors on the postsynaptic membrane at the neuromuscular junction. TCM TSQNM formulas have been widely utilized in clinical practice and have shown effectiveness in treating MG. There is a broad spectrum of traditional Chinese medicine (TCM) formulas with varying effectiveness, but there is a lack of direct comparative evidence between them. Bayesian network meta-analysis was utilized to evaluate the clinical efficacy and safety of TCM formulations that focus on spleen tonification, qi enhancement, and marrow nourishment (referred to as TSQNM) for treating myasthenia gravis. By leveraging available efficacy data, a comprehensive framework for clinical practice was established. The results are anticipated to provide valuable insights into the treatment of myasthenia gravis. Pertinent randomized controlled trials were retrieved from databases from the inception of the databases to October 17, 2023. The quality of studies was assessed using the risk of bias assessment tool developed by the Cochrane Collaboration. It was also pre-registered in PROSPERO (ID: CRD42023482260). Network meta-analysis was conducted using STATA16 and R4.2.3. Twenty studies were included, involving 1473 participants, with 739 cases in the experimental group and 734 cases in the control group. These studies examined the effectiveness of eight TCM formulas. Combining conventional Western medicine treatment (CWMT) with TSQNM formulas has been shown to provide superior therapeutic effects for patients with myasthenia gravis, compared to using prescription drugs alone. This combination therapy demonstrates no significant increase in the risk of adverse reactions. Notably, when Buzhong Yiqi Decoction is combined with CWMT, it has shown remarkable efficacy in reducing hormone-induced obesity and gastrointestinal tract discomfort. • This study involved 8 kinds of TCM prescriptions combined with CWMT for MG. • The effective rate and the incidence of adverse reactions were outcome indicators. • We determined the benefits of different combinations to guide clinical practice.