The effectiveness and safety of commercial Chinese polyherbal preparation in treating infantile anorexia: a systematic review and Bayesian network meta-analysis

Objective Commercial Chinese polyherbal preparations (CCPPs) are increasingly used for infantile anorexia (IA), but comparative effectiveness and safety differences among them remain unclear. This Bayesian network meta-analysis compares various CCPPs for IA to inform clinical practice. Methods We systematically searched CNKI, Wanfang, VIP, China Biology Medicine, PubMed, Web of Science, Embase, and Cochrane Library for RCTs on CCPPs for IA up to 9 April 2024. Study quality was assessed using the Cochrane RoB tool. Primary outcomes were overall effective rate, weight change, hemoglobin (Hb) levels, and adverse reactions. This research implemented Bayesian network meta-regression to ascertain the impact of different CCPPs and durations of treatment on the effectiveness and safety to treat IA. Results 141 RCTs (n = 16,963 patients; 49 CCPPs) were included. For overall effective rate, Huaji Oral Solution (HJKFY), Jianpi Pills + Reference Drug (JPW + RD), and Erkangning (EKN) showed significant superiority vs. control (all RR > 1.54, P < 0.05). Regarding weight change, Erpixing Granules (EPXKL) and Xiaoer Fufang Jineijin Chewable Tablets + RD (XEFFJNJJJP + RD) demonstrated significant benefits (MD = 2.26 and 2.10, P < 0.05 for XEFFJNJJJP + RD). For Hb levels, Jianbaoling Granules (JBLKL), Erbao Granules + RD (EBKL + RD), and Shenqu Xiaoshi Oral Solution + RD (SQXSKFY + RD) showed significant advantages (all MD > 10.72, P < 0.05). CCPPs exhibited a favorable safety profile, with mostly mild adverse reactions. Conclusion CCPPs are significantly more effective and safer than control treatments for IA. Different CCPPs excelled on specific outcomes: HJKFY for overall efficacy, EPXKL for weight gain, and JBLKL for Hb improvement. These findings require confirmation via larger, high-quality, multi-center RCTs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42024535550.