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Carica papaya extract in dengue: a systematic review and meta-analysis.

  • 2019-10-11
  • BMC complementary and alternative medicine 19(1)
    • Senaka Rajapakse
    • Nipun Lakshitha de Silva
    • Praveen Weeratunga
    • Chaturaka Rodrigo
    • Chathurani Sigera
    • Sumadhya Deepika Fernando

Study Design

Type
Meta-Analysis
Sample size
n = 580
Population
patients with suspected or confirmed dengue
Methods
Systematic review and meta-analysis of randomized or non-randomized trials comparing Carica papaya extract to standard treatment for dengue

Background

Carica papaya (CP) extract is becoming popular as an unlicensed herbal remedy purported to hasten recovery in dengue infection, mostly based on observations that it may increase platelet counts. This systematic review and meta-analysis aims to critically analyze the evidence from controlled clinical trials on the efficacy and safety of CP extract in the treatment of dengue infection.

Methods

PubMed, LILACS and Google Scholar were searched for randomized or non-randomized trials enrolling patients with suspected or confirmed dengue where CP extract was compared, as a treatment measure, against standard treatment. Recovery of platelet counts as well as other clinical indicators of favourable outcome (duration of hospital stay, prevention of plasma leakage, life threatening complications, and mortality) were assessed.

Results

Nine studies (India-6, Pakistan-1, Indonesia-1, Malaysia-1) met the inclusion criteria. Seven studies showed an increase in platelet counts in patients receiving CP extract, while one study showed no significant difference between the two groups, and direct comparison was not possible in the remaining study. Serious adverse events were not reported. CP extract may reduce the duration of hospital stay (mean difference - 1.98 days, 95% confidence interval - 1.83 to - 2.12, 3 studies, 580 participants, low quality evidence), and cause improvement in mean platelet counts between the first and fifth day of treatment (mean difference 35.45, 95% confidence interval 23.74 to 47.15, 3 studies, 129 participants, low quality evidence). No evidence was available regarding other clinical outcomes.

Conclusions

The clinical value of improvement in platelet count or early discharge is unclear in the absence of more robust indicators of favourable clinical outcome. Current evidence is insufficient to comment on the role of CP extract in dengue. There is a need for further well designed clinical trials examining the effect of CP on platelet counts, plasma leakage, other serious manifestations of dengue, and mortality, with clearly defined outcome measures.

Research Insights

  • Papaya→Increased Platelet Count

    improvement in mean platelet counts between the first and fifth day of treatment (mean difference 35.45, 95% confidence interval 23.74 to 47.15, 3 studies, 129 participants, low quality evidence)

    Effect
    Beneficial
    Effect size
    Small
  • Papaya→Reduced Hospital Stay Duration

    CP extract may reduce the duration of hospital stay (mean difference - 1.98 days, 95% confidence interval - 1.83 to - 2.12, 3 studies, 580 participants, low quality evidence)

    Effect
    Beneficial
    Effect size
    Moderate
  • Papaya→Reduced Life Threatening Complication

    No evidence was available regarding other clinical outcomes.

    Effect
    Neutral
    Effect size
    Small
  • Papaya→Reduced Mortality Risk

    No evidence was available regarding other clinical outcomes.

    Effect
    Neutral
    Effect size
    Small
  • Papaya→Reduced Plasma Leakage

    No evidence was available regarding other clinical outcomes.

    Effect
    Neutral
    Effect size
    Small

Adverse Events Reported

  • Papaya→Overall tolerability

    Serious adverse events were not reported.

    Finding
    Reported
    Severity
    Serious adverse event
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