Efficacy and Safety of Matrine Alkaloid Preparation in Combination with Nitroimidazoles in the Treatment of Trichomonal Vaginitis: A Systematic Review and Meta-Analysis

OBJECTIVES: To evaluate the efficacy and safety of matrine alkaloid preparation (MAP) in combination with nitroimidazoles in the treatment of trichomonas vaginitis (TV).

METHODS: PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, and CBM were searched for randomized controlled trials (RCTs) regarding the efficacy and safety of MAP and nitroimidazoles in the treatment of TV, the search period was from the establishment of the database to October 20, 2023. Two investigators independently performed literature screening, data extraction, and quality assessment in line with the inclusion and exclusion criteria. RevMan 5.4 was utilized to perform meta-analysis. (Protocol No. CRD42023478085)

RESULTS: A total of 6 RCTs involving 468 patients were included. The results of meta-analysis indicated that the combination of MAP and nitroimidazoles (combined regimen) improved the overall rate of clinical effectiveness for both drug-resistant TV (RR=1.27, 95%CI [1.09, 1.47], P=0.002) and ordinary TV (RR=1.14, 95%CI [1.02, 1.29], P=0.003) compared to nitroimidazoles monotherapy. In addition, combined regimen could also shorten the time for the duration of clinical symptoms, reduce the levels of IL-8, TNF-α, IL-13, IL-2, and vaginal pH value, increase the positivity rate of vaginal lactobacilli and H₂O₂, decrease the recurrent rate, and improve the quality of life of patients. Furthermore, the incidence of adverse events for combined regimen is similar to nitroimidazoles monotherapy.

CONCLUSIONS: Combined regimen is superior to nitroimidazoles monotherapy in term of efficacy in the treatment of TV, and it will not yet increase the risk of safety. However, the conclusion need to be further verified by high-quality RCTs with a large-sample size.