Evaluation of Traditional Chinese and Conventional Western Pharmacotherapies for Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis

Objectives This study aims to compare and rank the efficacy and safety of various therapies for amyotrophic lateral sclerosis (ALS), including riluzole, edaravone, traditional Chinese medicine (TCM), and numerous alternative therapies, and identify the remedies that demonstrate efficacy for patients with ALS. Methods The English literature sources for this study were collected from PubMed, and the Chinese literature were from Wipu, Wanfang, and China National Knowledge Infrastructure—using the search term “Mesh (ALS, treatment).” Types of studies include randomized trials or cohort studies, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to ensure transparency and reproducibility. Results Riluzole significantly reduced mortality compared with placebo (95% confidence interval [CI] 0.77 to 0.94, P = .002), whereas edaravone showed no statistically significant difference from placebo (95% CI 0.89 to 1.06, P = .58). After excluding one ineligible trial, TCM showed a statistically significant benefit (95% CI 0.52 to 0.85, P = .001). Survival time was significantly prolonged by TCM combined with riluzole (hazard ratio [HR] = 0.62, 95% CI 0.51–0.75) and by TCM alone (HR = 0.68, 95% CI 0.55–0.84) compared with placebo; however, the estimate for TCM alone was derived from a single small trial and should be interpreted with caution. Conclusions (1) Riluzole (100 mg/d) significantly improves survival versus placebo; (2) edaravone yields no significant overall clinical benefit, while potential efficacy is observed in specific patient subgroups; (3) TCM shows a favorable trend in prolonging survival when used alone or combined with riluzole; and (4) stem cell therapy requires further validation. Study limitations include the small number of TCM trials, short follow-up durations, lack of blinding in most TCM studies, and the absence of formal Grading of Recommendations Assessment, Development, and Evaluation or Confidence in Network Meta-Analysis evidence grading, necessitating cautious interpretation of the findings.