Effects of Chinese herbal medicine on reducing steroid-induced adverse reactions: A systematic review and meta-analysis from 1651 autoimmune disease patients in 18 randomized controlled trials

Introduction : Steroid-induced adverse reactions present significant challenges in the treatment of autoimmune diseases. Chinese herbal medicine, especially yin-nourishing formulations, shows potential for managing these adverse reactions. The objective of this review is to evaluate the effectiveness and safety of various types of Chinese herbal medicine, including herbal formulations, extracts, and single compounds, in preventing and managing the adverse reactions caused by steroids in patients with autoimmune diseases. Methods : We followed PRISMA guidelines to report this review. Randomized Controlled Trials (RCTs) which investigated the effectiveness and safety of Chinese herbal medicine, in any form and way of administration, on patients with steroid-induced adverse reactions, compared to any type of control, without language restrictions, were identified through electronic database searches. PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Database were systematically searched. All databases were screened up to March 2025. Retrieved data were both qualitatively and quantitatively synthesized. Risk of bias was assessed with the Cochrane risk-of-bias tool 2 and the following domains were considered: randomization, deviations from intended interventions, missing outcome data, outcome measurement, and selection of reported results. Each outcome’s quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, considering the risk of bias, inconsistency, indirectness, imprecision, and publication bias. Results : A total of 18 studies with 1651 participants were included in this meta-analysis, of which 14 studies were rated as high risk of bias and 4 were rated as some concerns. All the evidence generated from this study was moderate or very low based on GRADE system. Compared with standard care alone, adding Chinese herbal medicine during the treatments for autoimmune diseases yielded a significant reduction in the incidence of gastrointestinal disturbance (RR = 0.59, 95% CI: 0.41–0.84), infection (RR = 0.49, 95% CI: 0.34–0.70), insomnia (RR = 0.41, 95% CI: 0.32–0.54), hyperglycemia (RR = 0.36, 95% CI: 0.19 to 0.68), Cushing syndrome (RR = 0.55, 95% CI: 0.41–0.75), psychiatric adverse reactions (RR = 0.55, 95% CI: 0.44–0.69), abnormal heat sensation (RR = 0.51, 95% CI: 0.39–0.68), dizziness with tinnitus (RR = 0.55, 95% CI: 0.32–0.93), and xerostomia (RR = 0.51, 95% CI: 0.33–0.77). Adding Chinese herbal medicine also effectively treats the adverse reactions, including dizziness and tinnitus, and xerostomia induced by steroid use. Conclusion : Adding Chinese herbal medicine during the treatments among autoimmune diseases might not only prevent the occurrence of steroid-induced adverse reactions but also treat the adverse reactions caused by steroid use. Registry : The present systematic review was registered in PROSPERO under the following number: CRD420251016486.