Chinese herbal medicine for Henoch-Schönlein purpura in children without renal damage: a systematic review of randomized controlled trials

Background Henoch–Schonlein Purpura (HSP) is the most common necrotizing vasculitis affecting children. Traditional Chinese herbal medicine (CHM) was widely used. We aim to explore the evidence of effectiveness and safety of CHM for HSP in children without renal damage. Methods Randomized controlled trials (RCTs) comparing CHM with conventional medications were searched from five databases. Eligible data were pooled using random-effects model using RevMan 5.2 Subgroup analysis for different co-interventions and sensitivity analysis for reducing heterogeneity were implemented. GRADE approach was adopted. Results We included 15 trials with 1112HSP children (age 1–16 years old), disease duration one day to three months. The overall methodological quality of included trials is relatively low. Adjunctive oral CHM treatments reduced renal damage (6 trials, RR 0.47, 95%CI 0.31–0.72, I 2 =0%), and subsiding time (days) of purpura (5 trials, mean difference (MD) −3.60, 95%CI −4.21 to −2.99, I 2 =23%), joint pain (5 trials, MD −1.04, 95%CI −1.33 to −0.74, I 2 =1%) and abdomen pain (5 trials, MD −1.69, 95%CI −2.51 to −0.86, I 2 =74%). Subgroup and sensitivity analysis did not change the direction of results. No severe adverse events reported. Conclusions Orally taken adjunctive CHM treatments are effective for children suffering HSP in terms of reducing renal damage and subsiding time of purpura, and could possibly reduce subsiding pain of joint and abdomen. No reliable conclusion regarding safety is possible based on the safety data retrieved. Further rigorous trials are warranted.