Peer-reviewed article
Botanical drug preparations and related East Asian medicine interventions for central and idiopathic central precocious puberty: an umbrella review of systematic reviews and meta-analyses.
He Y, Zhuang S, Madenbayeva AM, Mussin NM, Tamadon A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a systematic review of botanical and East Asian medicine interventions for central precocious puberty in children. While it examines a medical condition affecting children, it focuses on pharmacological treatment efficacy and safety rather than broader child well-being outcomes. The review finds low-certainty evidence for adjunctive botanical preparations, particularly when combined with standard hormone treatments, but notes substantial methodological limitations in existing research.
Key points
- Four systematic reviews/meta-analyses met inclusion criteria, examining botanical drug preparations for central and idiopathic central precocious puberty
- Favorable signals reported for Zhibai Dihuang-based preparations, Dabuyin-based preparations, and combinations with GnRHa treatments
- Evidence certainty remains low due to heterogeneous formulations, unclear risk of bias in primary trials, incomplete formulation reporting, and possible publication bias
- Adverse events were incompletely defined and may have been under-reported; long-term pediatric safety was rarely assessed
- High-quality multicenter trials with standardized authentication, dosing, outcome definitions, and long-term follow-up are needed
Limitations
This is a highly specialized medical review focused on treatment efficacy for a specific endocrinological condition. It cannot provide evidence about general child health, development, protection, or participation outcomes, nor does it address broader determinants of child well-being.
Abstract
Background Central precocious puberty (CPP), particularly idiopathic CPP (ICPP), is characterized by the premature activation of the hypothalamic-pituitary-gonadal axis. Gonadotropin-releasing hormone agonists (GnRHas) are established biomedical treatments, but treatment burden, cost, and incomplete long-term outcome data have encouraged interest in adjunctive botanical drug preparations used in East Asian medicine. However, these preparations differ substantially in composition, dose, comparator, and reporting quality. Objectives The aim of this study is to synthesize systematic reviews (SRs) and meta-analyses (MAs) evaluating botanical drug preparations and related East Asian medicine interventions for CPP/ICPP, appraise methodological quality and certainty, quantify the overlap of primary trials, and identify evidence gaps. Methods Eligible studies included systematic reviews/meta-analyses of randomized trials in children with CPP/ICPP. Databases were searched from inception to September 2025. Evidence was narratively synthesized by formulation family, comparator, and outcome. Review quality was assessed using AMSTAR-2, risk of bias using ROBIS, certainty using GRADE domains where feasible, and primary-trial overlap using the corrected covered area. Results Four systematic reviews/meta-analyses were included. Favorable signals were reported mainly for Zhibai Dihuang-based preparations, Dabuyin-based preparations, Nourishing Yin-Purging Fire regimens, and botanical drug preparations combined with GnRHas. Outcomes included clinical response, uterine/ovarian volume, gonadotropin levels, estradiol levels, and bone age index. However, interpretation was limited by heterogeneous formulations, variable comparators, an unclear or high risk of bias in the primary trials, incomplete formulation reporting, possible publication/language bias, and overlap of primary studies. Adverse events were incompletely defined and may have been under-reported; long-term pediatric safety was rarely assessed. Conclusion Current evidence suggests a possible adjunctive benefit of selected botanical drug preparations, particularly in combination with GnRHas, for CPP/ICPP. However, the certainty of the evidence remains low because of methodological weaknesses, heterogeneous interventions, single-country evidence, incomplete safety reporting, and limited long-term outcome data. High-quality multicenter trials with standardized botanical authentication, dosing, outcome definitions, adverse-event surveillance, and long-term follow-up are needed before routine clinical integration can be recommended.