Genus Phyllanthus for chronic hepatitis B virus infection: a systematic review

To evaluate the efficacy and safety of genus Phyllanthus for chronic hepati tis B virus (HBV) infection we performed a systematic review of randomized clinical trials. Randomized trials comparing genus Phyllanthus vs. placebo, no intervention, general nonspecific treatment, other herbal medicine, or interferon treatment for chronic HBV infection were identified by electroni c and manual searches. Trials of Phyllanthus herb plus interferon (IFN) vs. IFN alone were also included. No blinding and language limitations were ap plied. The methodological quality of trials was assessed by the Jadad scale plus allocation concealment. Twenty-two randomized trials (n = 1947) were identified. The methodological quality was high in five double-blind trials and low in the 17 remaining trials. The combined results showed that Phyll anthus species had positive effect on clearance of serum HBsAg (relative ri sk 5.64, 95% CI 1.85-17.21) compared with placebo or no intervention. There was no significant difference on clearance of serum HBsAg, HBeAg and HBV D NA between Phyllanthus and IFN. Phyllanthus species were better than nonspe cific treatment or other herbal medicines for the clearance of serum HBsAg, HBeAg, HBV DNA, and liver enzyme normalization. Analyses showed a better e ffect of the Phyllanthus plus IFN combination on clearance of serum HBeAg ( 1.56, 1.06-2.32) and HBV DNA (1.52, 1.05-2.21) than IFN alone. No serious a dverse event was reported. Based on this review Phyllanthus species may hav e positive effect on antiviral activity and liver biochemistry in chronic H BV infection, However, the evidence is not strong due to the general low me thodological quality and the variations of the herb. Further large trials a re needed.