Efficacy and safety of Ophiocordyceps sinensis in the treatment of Hashimoto's thyroiditis: a systematic review and meta-analysis.

2023-10-03
Frontiers in pharmacology 14
- Maoying Wei
- Wenxin Ma
- Wenhua Zhang
- Dan Yin
- Yiting Tang
- Weiyu Jia
- Yijia Jiang
- Churan Wang
- Yanbing Gong

PubMed: 37854714
DOI: 10.3389/fphar.2023.1272124

Study Design

Type: Systematic Review
Sample size: n = 14
Population: patients with Hashimoto's thyroiditis
Methods: Meta-analysis of 14 RCTs using Revman 5.3, GRADE system for certainty

Objective: To evaluate the efficacy and safety of Ophiocordyceps sinensis (OS) preparations for the treatment of Hashimoto's thyroiditis (HT). Methods: We searched eight databases to collect randomized controlled trials (RCTs) of OS combined with a low-iodine diet or levothyroxine for HT. The search period was from inception to June 2023. Meta-analysis was performed using Revman 5.3 software after two evaluators independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. The GRADE system was used to assess the certainty of evidence. Results: A total of 14 RCTs involving 1,014 patients with HT were included. Meta-analysis showed that OS preparations combined with a low-iodine diet were more effective in reducing thyroid peroxidase antibody (TPOAb) [SMD = -3.81, 95% CI (-5.07, -2.54), p < 0.00001] and thyroglobulin antibody (TgAb) [SMD = -4.73, 95% CI (-6.86, -2.61), p < 0.00001] compared to a low-iodine diet. Compared with levothyroxine treatment alone, OS preparations combined with levothyroxine further reduced TPOAb [SMD = -2.04, 95% CI (-2.82, -1.26), p < 0.00001], TgAb [SMD = -2.01, 95% CI (-2.68, -1.33), p < 0.00001], tumor necrosis factor alpha (TNF-α) [SMD = -3.40, 95% CI (-5.66, -1.14), p = 0.003], interleukin-2 (IL-2) [SMD = -2.31, 95% CI (-3.98, -0.65), p = 0.006], and interleukin-6 (IL-6) [MD = -4.16, 95% CI (-6.17, -2.15), p < 0.0001], and elevated free thyroxine (FT4) [SMD = 1.34, 95% CI (0.59, 2.08), p = 0.0004], but no significant effect on free triiodothyronine (FT3) [SMD = 0.83, 95% CI (-0.12, 1.78), p = 0.09] and thyroid stimulating hormone (TSH) [SMD = -0.80, 95% CI (-1.71, 0.11), p = 0.08]. In terms of safety, three studies reported adverse reactions in 10 patients in each of the experimental and control groups. Conclusion: OS preparations in combination with other treatments (low-iodine diet or levothyroxine) may decrease thyroid autoantibodies and inflammatory responses in patients with HT. In HT patients with hypothyroidism, the combination of the OS preparations with levothyroxine also improved FT4. However, the quality of the included studies was generally low. Moreover, the safety of OS preparations remains unclear. Therefore, more high-quality, multicenter, large-sample RCTs are needed in the future to validate the efficacy and safety of OS preparations. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42023432663.

Research Insights

Cordyceps→Increased Free Triiodothyronine Level
no significant effect on free triiodothyronine (FT3) [SMD = 0.83, 95% CI (-0.12, 1.78), p = 0.09]
Effect
Neutral
Effect size
Small
Cordyceps→Increased Serum Free Thyroxine Levels
Compared with levothyroxine treatment alone, OS preparations combined with levothyroxine further reduced ... and elevated free thyroxine (FT4) [SMD = 1.34, 95% CI (0.59, 2.08), p = 0.0004]
Effect
Beneficial
Effect size
Large
Cordyceps→Reduced Interleukin-6 Levels
Compared with levothyroxine treatment alone, OS preparations combined with levothyroxine further reduced ... interleukin-6 (IL-6) [MD = -4.16, 95% CI (-6.17, -2.15), p < 0.0001]
Effect
Beneficial
Effect size
Moderate
Cordyceps→Reduced Thyroglobulin Antibody Level
Compared with levothyroxine treatment alone, OS preparations combined with levothyroxine further reduced ... TgAb [SMD = -2.01, 95% CI (-2.68, -1.33), p < 0.00001]
Effect
Beneficial
Effect size
Large
Cordyceps→Reduced Thyroid Peroxidase Antibody Level
Compared with levothyroxine treatment alone, OS preparations combined with levothyroxine further reduced TPOAb [SMD = -2.04, 95% CI (-2.82, -1.26), p < 0.00001]
Effect
Beneficial
Effect size
Large
Cordyceps→Reduced Tumor Necrosis Factor Alpha
Compared with levothyroxine treatment alone, OS preparations combined with levothyroxine further reduced ... tumor necrosis factor alpha (TNF-α) [SMD = -3.40, 95% CI (-5.66, -1.14), p = 0.003]
Effect
Beneficial
Effect size
Large
Cordyceps→Reduced Waist-to-Height Ratio
no significant effect on ... thyroid stimulating hormone (TSH) [SMD = -0.80, 95% CI (-1.71, 0.11), p = 0.08]
Effect
Neutral
Effect size
Small

Adverse Events Reported

Cordyceps→Overall tolerability
In terms of safety, three studies reported adverse reactions in 10 patients in each of the experimental and control groups.
Finding
Reported
Magnitude
10 patients in each of the experimental and control groups