Traditional Chinese medicine shows benefit in patients with HFrEF | Latest news for doctors, nurses and pharmacists

Treatment with qiliqiangxin (QLQX), a traditional Chinese medicine (TCM), significantly reduces the risk of heart failure hospitalization and cardiovascular (CV) death in patients with heart failure and reduced ejection fraction (HFrEF), according to the QUEST trial. *Presented at ESC 2023.

QLQX capsule is a traditional Chinese medicine extract obtained from a mixture of 11 herbs, including astragali root, ginseng root and rhizome, Aconitum savage root preparation, Salvia miltiorrhiza root and rhizome, Dioscorinia lepidii seed, Alismatia root, Polygonata rhizome, cinnamon twig, The safflower, the pericarp, and the reticulum of citrus fruits. (GM Coll Cardiol 2013;62:1065-1072)

In 2004, QLQX was approved in China for the treatment of chronic heart failure (CHF). “It reflects the concept of diuretic, vasodilator and cardiotonic agents for treating heart failure in modern medicine,” said lead author Professor Xinlei Li from The First Affiliated Hospital of Nanjing Medical University in Nanjing, China.

The previous study demonstrated that patients with chronic heart failure who received QLQX and were receiving standard background therapy for HF achieved a significant reduction in pro-B type N-type natriuretic peptide (NT-proBNP) levels and improved NYHA, LVEF, and QOL functional status. Life during a 12-week treatment period. (GM Coll Cardiol

Hence the current study Aims To further evaluate efficacy and safety
Long-term use of QLQX in patients with HFrEF.

The researchers conducted a prospective, double-blind, multicenter, placebo-controlled study including 3,110 patients with HFrEF (median age 63 years, 70% male) recruited from 133 hospitals in mainland China and Hong Kong, China. The median baseline LVEF was 32 percent and the median NT-proBNP level was 1,692 pg/mL. Participants were randomized 1:1 to receive either QLQX (four capsules, three times daily) or placebo (n = 1,555 in each group) in addition to standard medications for congestive heart failure.

At a median follow-up of 18.3 months, QLQX significantly reduced the risk of the primary composite endpoint of disease.
Cardiovascular death and hospitalization for heart failure decreased by 22 percent compared with placebo (25 percent versus 30 percent; hazard ratio (HR), 0.78; P < 0.001). (ESC 2023, Hotline Session 2)

When the individual components of the composite endpoint were evaluated separately,
QLQX was also associated with Significant reduction in the risk of hospitalization (HR, 0.76; P = 0.002) and CV death (HR, 0.83; P = 0.045) compared with placebo.

The effect of QLQX on the primary outcome was generally positive
Consistent across prespecified subgroups of patients with ischemic aetiology (HR, 0.76; P < 0.001) and those who did not receive Western guideline-guided primary medical therapies, such as triple therapy with RAASi + Beta-blocker + MRA (HR, 0.74 ; p) = 0.003) or baseline ARNi (HR, 0.77; p = 0.012).

“These risk reductions were significant and clinically important,” Lee noted.

Regarding safety endpoints, there was no significant difference between the QLQX and placebo groups in the rates of all-cause mortality (14.21 percent vs. 16.85 percent; P = 0.058) or adverse events (82.83 percent vs. 84.18 percent; p=0.058). Probability = 0.334). . “QLQX capsules are generally safe and well tolerated,” Lee said.

“To our knowledge, this was the first randomized, double-blind trial of traditional Chinese medicine for the treatment of congestive heart failure. Our findings show a meaningful clinical benefit with QLQX in patients with HFrEF, which supports the use of QLQX as a treatment,” Li said in a press release. Adjuvant to the treatment of HF.

It was suggested that QLQX capsule should be further explored as a new treatment option for patients with HFrEF.

Invited Professor Caroline Lam from the National Heart Center in Singapore, who was not affiliated with the study, commented: “This trial provides much-needed long-term results for QLQX in HFrEF.

“The QUEST program sets a new standard for clinical evidence using traditional medicines, which truly challenges the strictly reductionist approach of Western medicine,” she added.

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