Efficacy, safety and treatment costs of Lanqin oral liquid for hand, foot and mouth disease in children: A systematic review and meta-analysis of randomized controlled trials

Lanqin oral liquid (LOL) is often used for children with hand, foot and mouth disease (HFMD). This systematic review evaluated its efficacy, safety and treatment costs. 8 Chinese and English databases and 2 registries were searched from their inception to 2022. Risk of bias was assessed by ROB 2 and pooled effect was conducted by RevMan 5.4. Required sample size was calculated, and quality of evidence body was appraised by the GRADE method. 49 RCTs involving 6379 children were identified. Most RCTs had a high risk of bias. LOL used alone reduced fever clearance time (MD -0.82 day, 95% CI [-1.14, -0.51]), skin eruption elimination time (MD -1.08 days, 95% CI [-1.19, -0.96]), mouth herpes or ulcer elimination time (MD -1.62 days, 95% CI [-2.38, -0.86]) compared with ribavirin. Combining with antiviral drugs also reduced fever clearance time (MD -1.26 days, 95% CI [-1.39, -1.12]), skin eruption elimination time (MD -1.78 days, 95% CI [-2.00, -1.55]), mouth herpes or ulcer elimination time (MD -1.55 days, 95% CI [-1.81, -1.29]) than antiviral drugs, which showed 'low' or 'very low' quality. Adverse drug reactions were reported in several trials but no treatment costs were reported. Low or very low evidence demonstrated LOL appeared to be effective and safe on reducing fever clearance time, elimination time for skin eruptions, mouth herpes and ulcers for children with HFMD, improving total effective rate and enhancing immune function. Further well-designed RCTs especially evaluating LOL used alone are warranted to explore its benefit and cost effectiveness.