Rehmannia glutinosa for perimenopausal syndrome in patients with breast cancer: A systematic review and meta-analysis.

Objectives: To carry out a quantitative assessment of the therapeutic effect of Chinese herbal medicine (CHM), with Rehmannia glutinosa as the main ingredient, in treating perimenopausal syndrome (PMS) in breast cancer patients.

Methods: Randomized controlled trials (RCTs) comparing CHM with Rehmannia glutinosa as the principal ingredient and Western medicine in treating PMS among breast cancer patients were retrieved from multiple databases. These databases included PubMed, Cochrane library, Embase, China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database, and China Biology Medicine Database. The primary outcome was the change in the Kupperman index by the end of the follow-up period. Secondary outcomes were changes in Karnofsky performance status (KPS), the functional assessment of cancer therapy - breast (FACT-B), the percentages of T-cells, levels of gonadal hormones, and tumor markers in peripheral blood at the end of follow-up, and adverse events.

Results: The meta-analysis included 17 RCTs involving 1,139 patients showing that CHM with Rehmannia glutinosa as the monarch drug significantly improved the Kupperman index (MD= -12.79, p<0.01), KPS score and increased the percentage of CD4 cells, reduced the percentage of CD8 cells, and improved the CD4/CD8 ratio in peripheral blood, compared to Western medicine. There were no significant differences in FACT-B scores. Levels of gonadal hormones in peripheral blood did not exhibit significant variations, and no severe adverse reactions were detected.

Conclusion: These data suggest that CHM with Rehmannia glutinosa as the monarch drug may be applied in the treatment of PMS in patients with breast cancer. These results should be considered in the context of the methodological flaws and high heterogeneity of the included RCTs.PROSPERO No. ID: CRD42022384810.