Effectiveness and Safety of Combination Therapy with Herbal Medicine and Growth Hormone Compared to Growth Hormone Monotherapy for Short Stature Children: A Systematic Review and Meta-Analysis

Table 1

Summary of findings.

Patients or population: idiopathic short stature
Intervention: CHG
Comparison: GH monotherapy
Outcomes	Anticipated absolute effects (95% CI)		Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)
	Risk with GH monotherapy	Risk with CHG
Height (cm)	The mean height (cm) was 0	MD 3.32 (2.7–3.93) higher	—	420 (5 RCTs)	⊕⊕○○ LOW^a,b
Change in height SDs	The mean change in height SDS was 0	MD 0.31 (0.24–0.38) higher	—	128 (2 RCTs)	⊕⊕⊕○ MODERATE^a
Weight (kg)	The mean weight (kg) was 0	MD 2.47 (1.83–3.11) higher	—	186 (2 RCTs)	⊕⊕⊕○ MODERATE^a
Growth velocity (cm/year)	The mean growth velocity (cm/year) was 0	MD 1.82 (1.34–2.31) higher	—	584 (6 RCTs)	⊕○○○ VERY LOW^a,b,c
IGF-1 (ng/mL)	The mean IGF-1 was 0	MD 61.85 (55.8–67.9) higher	—	153 (3 RCTs)	⊕⊕○○ LOW^a,b
IGFBP-3 (ng/ml)	—	SMD 1.39 (0.93–1.85) higher	—	93 (2 RCTs)	⊕⊕⊕○ MODERATE^a
Adverse events	144 per 1 000	14 per 1 000 (3–78)	RR 0.10 (0.02–0.54)	173 (3 RCTs)	⊕⊕○○ LOW^a,b

GRADE Working Group grades of evidence; High certainty: We are very confident that the true effect lies close to that of the estimate of the effect; Moderate certainty: We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; Low certainty: Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect; Very low certainty: We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of the effect. The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ^aIn all RCTs, the blinding of participants and personnel was incomplete. ^bConfidence intervals cross null effect. ^cHeterogeneity is very high (I² = 92%). CI, confidence interval; MD, mean difference; SDs, standard deviation; SMD, standardized mean difference; RR, risk ratio.