China leads COVID-19 research in traditional, complementary, and integrative medicines, followed by India, US
Products that were being studied the most were Chinese medicine, individual health supplements (vitamins, minerals), combination health supplements and others (Ayurvedic medicine).
In 2020, there has been an increasing number of studies to include TCIMs in the management or treatment of COVID-19.
These TCIMs have shown positive effects on improving clinical symptoms and complementing standard medications.
Researchers from South Korea sorted through online databases to study the trends in COVID-19 publication trends, and published the findings in Integrative Medicine Research.
In this study, TCIMs include Chinese medicine such as Chinese herbal decoction and Chinese patent medicine, health supplements such as vitamin C, D, herbs and zinc, propolis like omega-3, and others such as Ayurvedic medicine.
Researchers sieved through six databases PubMed, Embase, Allied and Complementary Medicine Database (AMED) and China, being the country that first considered TCIM approach for COVID-19 and issued relevant national guidelines, three major Chinese databases were also included in the literature search including China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Science and Technology Periodical Database (VIP).
Only randomised controlled trials (RCTs) relating to TCIM for the management or treatment of COVID-19 were included.
Due to the nature of the novel infection, all TCIM interventions whether treatment or control groups were given standard medications for COVID-19 such as antibiotics, antiviral and anti-inflammation drugs.
A total of 56 studies were included, of which 24 were published in English journals, and 22 in Chinese journals, with impact factors ranging from 0.220 to 56.272.
Of the 56 trials, 54 focused on the treatment, while two focused on the rehabilitation of COVID-19 using TCIM approach.
A total of 5,932 participants were involved across all 56 trials, and most trials were small to medium sample-sized studies, very few studies had large sample size of more than 200 study participants. 87% of subjects were COVID-19 positive, the rest were suspected cases.
China published the most number of studies (n=41), followed by India (n=5), US (n=4), Iran (n=4), Belgium, Brazil, Australia, Canada, Germany, Pakistan, Saudi Arabia, Spain and Turkey.
Most of these publications were affiliated with one country (n=51), although seven articles were affiliated with two countries.
Not surprising, the most commonly studied TCIM modalities were Chinese medicine (n=37), followed by health supplements, propolis, and others.
Among Chinese medicine, Chinese herbal decoction and Chinese patent medicine were the most commonly studied. Some examples are Qingfei Paidu and Lianhua qingwen granules which have been identified as the representative traditional Chinese medicine effective in treating COVID-19 in prior review studies.
While Chinese medicine seemed to be published in more articles, researchers observed that health supplements such as vitamin C, vitamin D, and zinc have been published in high impact factors journals or have a higher number of citations.
“This indicates that health supplements, with a relatively smaller proportion of studies published, gain more attention and recognition among researchers and journals,” they said.
This study also included English and Chinese journals, which excludes other studies published in other languages. “It is possible that several TCIM-focused RCTs are published in their native language or local journals. However, such articles are often hard to capture as they are less accessible to authors and there could be other forms of less known TCIM modalities that were overlooked in this analysis.”
In the current analysis, there were few studies focused on TCIM modalities such as Ayurveda and mind-body practices, showing the potential for future research.
Researchers said studying publications trends can help better understand the quantity and quality of these TCIM-focused COVID-19 studies.
There are still many research gaps in the pandemic research of TCIM which requires the evaluation of study designs for more rigorous research from various countries.
For example, the use of hydroxychloroquine surged immediately after the publication of open-label, non-randomised, small-sampled trial claiming its effectiveness and was later shown to be no different from placebo and revoked in a well-designed RCT with large sample size.
“RCTs with suboptimal designs will not help either patients or clinicians and may result in significant ethical lapse. Instead of allowing exceptionalism, researchers should coordinate their studies to uphold the gold standard of RCT to contribute to the advancement of clinical evidence base for COVID-19,” researchers wrote.
This research was supported by the Korea Institute of Oriental Medicine.
Source: Integrative Medicine Research
“Randomized controlled trials of traditional, complementary, and integrative medicine-based interventions for coronavirus disease 2019 (COVID-19): a bibliometric analysis and review of study designs”
Authors: Lin Ang, et al.