Qian lie an suppository (prostant) for chronic Prostatitis : A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Chronic prostatitis (CP) is an inflammation of the prostate gland that seriously affects the quality of life of patients. The existing evidence of antibiotics and a-blockers for the treatment of CP is limited. Objectives: This review evaluated the effectiveness and safety of Qian Lie An Suppository (Prostant) in treating CP. Methods: Randomized controlled trials comparing Prostant (alone or plus the control) with placebo, conventional drugs, or nonpharmaceutical therapies for CP were included in this article through searching from 6 databases. Data were analyzed using RevMan 5.3 software. Meta-analysis was performed when the clinical or statistical heterogeneity was found acceptable among trials. Estimate effects were present with risk ratio (RR) or mean difference and their 95% confidence interval (CI) for dichotomies or continuous variables. Quality of the evidence for each primary outcome was assessed using GRADE criteria. Results: Totally 21 trials involving 3359 participants were included. There were 2 included trials had unclear risk of bias, and the remaining trials had high risk of bias. Meta-analyses showed the number of cured patients in the Prostant group was 2 times more than that of the placebo (RR 2.05, 95%CI 1.10 to 3.81) or antibiotics (RR 1.95, 95%CI 1.18 to 3.23) groups. Similar results were found when Prostant in combination with antibiotics or hyperthermia compared with the antibiotics (RR 1.78, 95% CI 1.10-2.89) or hyperthermia (RR 1.72, 95% CI 1.23-2.40) alone. However, there was no difference in the number of cured patients between Prostant and a-blockers or hyperthermia therapy. No severe adverse event was reported in all included trials. The main adverse events in Prostant group were reported (in 8 included trials) as diarrhea and anal discomfort. Conclusions: Low-quality evidence showed that the Prostant may have add-on effect for patients with CP on increasing the number of cured patients, relieving pain, and improving the quality of life. There is not sufficient evidence to determine the effectiveness and safety of Prostant for the treatment of CP compared with placebo, antibiotics, a-blockers or the hyperthermia therapy. Abbreviations: CAP = chronic abacterial prostatitis, CBP = chronic bacterial prostatitis, CI = confidence interval, CNKI = Chinese National Knowledge Infrastructure Databases, CP = chronic prostatitis, EPS-WBC = expressed prostatic secretions-white blood cells, FEM = fixed-effect model, GRADE = Grading of Recommendations Assessment, Development and Evaluation criteria, MD = mean difference, NIH-CPSI = National Institute of Health-Chronic Prostatitis Symptoms Index, RCTs = randomized controlled trials, REM = random-effect model, RR = risk ratio, VIP = the Chongqing VIP China Science and Technology Journal Database.