Efficacy and safety of six Chinese patent medicines for elderly functional constipation: a network meta-analysis

Background: Functional constipation (FC) is a prevalent condition in the elderly that greatly reduces quality of life. Combined treatment using Chinese Patent Medicine (CPM) and Western Medicine (WM) is frequently employed; however, the comparative efficacy and safety of various CPMs are unclear. Objective: To assess and compare the efficacy and safety of six regularly used CPMs combined with WM in the treatment of elderly FC patients. Methods: A systematic search was performed in eight electronic databases from their inception through May 31, 2025. Two reviewers independently evaluated studies, gathered data, and calculated the risk of bias using the Risk of Bias 2 tool. The level of evidence certainty was rated using GRADE. The Bayesian network meta-analysis (NMA) was conducted using R software (version 4.5.0). The effect sizes were shown as relative risk, mean difference, standardized mean difference, and 95% credible intervals (CrIs). Interventions were ranked according to the surface under the cumulative ranking curve (SUCRA). Results: Twenty-three randomized controlled trials (2,065 participants) involving six CPMs were included. The certainty of evidence for all outcomes was rated as low or very low, and an unclear or high risk of bias, which may have overestimated treatment effects. CPMs plus WM generally improved overall response compared with WM alone. SUCRA rankings suggested that Congrong Tongbian Oral Liquid + WM and Liuwei Anxiao Capsule + WM had higher probabilities of being among the top options for overall response; however, several comparisons were informed by few trials, and the evidence was of low/very low certainty. Therefore, SUCRA-based rankings should be considered exploratory and hypothesis-generating rather than definitive indicators of clinical superiority. Adverse-event reporting was inconsistent and mostly involved mild reactions (e.g., abdominal pain, diarrhea, bloating); however, definitions and ascertainment were often not described and participant-level incidence was frequently unavailable, limiting comparative safety conclusions, and the absence of reported serious adverse events should not be interpreted as evidence that serious events did not occur. Conclusion: CPMs plus WM may offer potential benefits for elderly patients with FC. However, given the low/very low certainty of evidence, prevalent risk-of-bias concerns, and limitations in safety reporting, definitive comparative conclusions or practice recommendations cannot currently be made. These findings should be regarded as exploratory signals requiring confirmation in adequately powered, rigorously designed multicenter randomized controlled trials with stringent adverse-event monitoring and extended follow-up. Accordingly, no strong clinical recommendations favoring any specific CPM can be made based on current evidence. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251087886, identifier CRD420251087886.