Chinese herbal medicine for people with multiple sclerosis: Protocol for a systematic review and meta-analysis

Introduction: Multiple sclerosis (MS) is a common demyelinating disease of the central nervous system. Chinese herbal medicine (CHM) is widely used to treat MS in China. However, to date, CHM treatments are not supported with conclusive evidence. The aim of this study is to assess the effectiveness and adverse effects of CHM in people with MS. Methods: We will search medical databases for randomised controlled trials or cross-over trials published from inception to the current date with no language restrictions. We will include studies involving adults diagnosed with MS, comparing all forms of CHM with placebo, no intervention, or any other intervention. Outcomes of interest include the number of disability worsening, relapse, quality of life, magnetic resonance imaging, cognitive function, the change of fatigue, TCM Syndrome Differentiation Efficacy Scales, and adverse event. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers will independently screen the studies, assess eligibility, and extract data from each study. Any disagreements will be resolved by the third reviewer. Heterogeneity will be investigated using a combination of visual inspection of the forest plot along with consideration of the I2 and chi 2 tests. Risk of bias will be assessed using the Cochrane 'Risk of bias 2 ' tool. The quality of evidence for each outcome will be assessed using GRADE. RevMan V.5.4.1 will be used for synthesis and subgroup analysis. Discussion: This protocol for a systematic review will provide a summary of the evidence regarding the effec-tiveness and adverse effects of CHM in the treatment of patients with MS. We hope this comprehensive synthesis will help healthcare professionals, patients and families to make informed treatment choices for MS treatment. Registration: International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 06 May 2022 (INPLASY202250035).