Role of Xingnaojing Injection in treating acute cerebral hemorrhage A systematic review and meta-analysis

Background: Xingnaojing injection (XNJi) is widely used for acute cerebral hemorrhage. However, the efficacy of XNJi for acute cerebral hemorrhage has not been comprehensively proved by systematic analysis yet. Therefore, it is essential to evaluate the efficacy and safety of XNJi in an evidence-based method. Methods: Six databases were searched with XNJi used for acute cerebral hemorrhage in randomized controlled trials (RCTs). Meta-analysis was performed by Review Manager 5.3. The efficacy rate, brain edema, cerebral hematoma, neurological deficit score, hs-crp, Glasgow Coma Scale (GCS), and activities of daily living (ADL) were systematically evaluated. The Cochrane risk of bias was used to evaluate the methodological quality of eligible studies. Results: This study is registered with PROSPERO (CRD42018098737). Twenty-nine studies with a total of 2638 patients were included in this meta-analysis. Compared with conventional treatment, XNJi got higher efficacy rate (OR=3.37, 95% CI [2.65, 4.28], P<.00001). Moreover, XNJi showed significant enhancement of efficacy rate via subgroup analysis in course and dosage. In addition, XNJi demonstrated significant improvement in Chinese stroke scale (CSS) and National Institutes of Health Stroke Scale (NHISS) (mean difference [MD]=-4.74, 95% CI [-5.89, -3.60], P<.00001; MD=-4.45, 95% CI [-5.49, -3.41], P<.00001), GCS (MD=2.72, 95% CI [2.09, 3.35], P<.00001). It also remarkably decreased the level of hs-crp (MD=-6.50, 95% CI [-7.79, -5.21], P<.00001), enhanced ADL (MD=20.38, 95% CI [17.98, 22.79], P<.00001), and alleviated hematoma and edema (MD=-2.53, 95% CI [-4.75, -0.31] P<.05; MD=-1.74 95% CI [-2.42, -1.07] P<.00001) compared with conventional treatment. Conclusion: XNJi is effective in treating acute cerebral hemorrhage with significant improvement of CSS, NHISS and impairment of hs-crp, hematoma, and edema compared with conventional treatment. Moreover, XNJi got remarkable efficacy at the dose of 20, 30, 60mL and from 7 to 28 days. No serious adverse reactions occurred. These results were mainly based on small-sample and low-quality studies. Therefore, more rigorous, large-scale RCTs were further needed to confirm its efficacy, safety, and detailed characteristic of application.