Peginterferon plus Chinese herbal therapy is associated with a higher virological response than only peginterferon therapy in chronic hepatitis C

Traditional Chinese herbal therapies are widely used for the treatment of chronic hepatitis C (CHC) in China and several Asian countries. The aim of this study was to perform a meta-analysis of randomized controlled trials (RCTs) comparing peginterferon therapy with peginterferon plus Chinese herbal therapy for the treatment of CHC. The Cochrane Central Register of Controlled Trials, Medline, Science Citation Index, EMBASE, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Database were searched to identify RCTs that evaluated the virological response of CHC patients to peginterferon therapy and peginterferon plus Chinese herbal therapy. We statistically combined data using a fixed-effects meta-analysis according to the intention-to-treat principle. The literature search yielded 905 studies and nine RCTs composed of 858 patients matched the selection criteria. Overall, sustained virological response (SVR) was significantly higher in patients treated with peginterferon plus Chinese herbs than in patients treated with peginterferon alone (81 % vs. 64 %, respectively; odds ratio, 2.60; 95 % confidence interval: 1.32-5.14; p < 0.05). A combined therapy of peginterferon plus Chinese herbs was also superior to peginterferon therapy in achieving an early viral response (EVR, 80 % vs. 70 %, respectively), a viral response at week 24 of treatment (82 % vs. 73 %, respectively), and end-of-treatment viral response (ETVR, 73 % vs. 62 %, respectively). The combined therapy resulted in fewer relapses, fewer adverse events, and more rapid alanine transaminase normalization; however, both treatments yielded a similar rapid viral response (RVR, 53 % vs. 57 %, respectively). The current evidence suggests that combined therapy of peginterferon plus Chinese herbs yields a higher viral response and results in fewer relapses and fewer adverse events than peginterferon therapy alone.