Comparative effectiveness of ten CPMs for acute exacerbation of chronic obstructive pulmonary disease: systematic review and network meta-analysis

Background Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a prevalent acute respiratory disease in China, necessitating effective treatments. Purpose To investigate the therapeutic and safety profiles of Chinese patent medicines (CPMs) for AECOPD. Methods Randomized controlled trials (RCTs) investigating CPMs for AECOPD were retrieved from PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wanfang, and CBM. Reviewers independently conducted study selection, data extraction, and bias risk using the Cochrane RoB 2.0. The principal endpoints included total effective rate and pulmonary function parameters; secondary endpoints comprised arterial blood gas indices, inflammatory markers, and adverse events. A frequentist-based analytical strategy was utilized, with StataSE 18.0 for analysis. Results 84 RCTs comprising 8,477 participants and 10 CPMs were included. ZCL showed the greatest improvement in total effective rate (RR 4.26, 95% CI 2.24–8.09; SUCRA 72.4%). SWLDH ranked highest for FVC (MD 0.58, 95% CI 0.29–0.87; SUCRA 94.5%) and FEV 1 (MD 0.85, 95% CI 0.56–1.15; SUCRA 98.0%). QKL demonstrated the most significant effect on FEV 1 /FVC (MD 8.57, 95% CI 3.80–13.34; SUCRA 87.0%) and also ranked first for pH. XZL was superior in PaO 2 and IL-6, while RDN best reduced PaCO 2 and IL-8. QQHT was most effective for TNF-α. The analysis found no statistically significant increase in the risk of adverse events for any CPM + CT, compared to CT alone. The level of evidence certainty was categorized as low or very low. Conclusion CPMs may improve total effective rate, pulmonary function, blood gas parameters, and inflammatory markers in AECOPD. However, these findings require confirmation by high-quality studies. Systematic review registration [ https://www.crd.york.ac.uk/PROSPERO/view/ ], identifier [CRD420251059887].