Even though the superior efficacy of IGU in RF and ESR was shown in the comparison of IGU + GC vs. Schirmers check result, EULAR Sj?grens Symptoms Individual Reported Index (ESSPRI), EULAR Sj?grens Symptoms Disease Activity Index (ESSDAI), and effectiveness price ( 0.01) in comparison to individuals treated with HCQ + GC. In comparison to treatment with GC and HCQ, co-administration of IGU with GC showed significant variations in RF and ESR level ( 0.01); nevertheless, no significant variations were mentioned in IgG level. Conversely, the IgG level demonstrated a substantial improvement in the IGU + HCQ + GC group set alongside the HCQ + GC group. The outcomes of protection analysis exposed that seven tests demonstrated no significant variations in adverse occasions (AEs) between your IGU + HCQ + GC and HCQ + GC organizations (= 0.15). Although no serious AEs were mentioned, gastrointestinal distress was the most frequent AE in the IGU group. Zero significant differences in AEs had been observed between your IGU + HCQ and GC + GC organizations. Summary: IGU improved the medical symptoms of individuals with pSS, including inflammatory signals (ESR, IgG, and RF amounts), PLT count number, secretion function from the salivary and lacrimal glands (salivary movement rate and Schirmers test result), and disease indexes (ESSDAI and ESSPRI), when co-administered with HCQ + GC therapy without increasing the risks of AEs. Consequently, IGU can be considered as an effective and safe drug Vatalanib free base for medical therapy of pSS. Considering the limitations of the present trials, more long-term, multicenter, and high-quality RCTs are required to assess the performance and security of IGU for treating individuals with pSS. 0.1 in the chi-squared test or IkappaBalpha = 0%, 0.00001), RF (MD = -5.79, 95% CI: -7.77 -3.80, = Vatalanib free base 0%, 0.00001), ESSPRI (MD = -2.03, 95% CI: -2.11 -1.94, = 39%, 0.00001), and effectiveness rate (OR = 3.87, 95% CI: 2.44 6.15, = 0%, 0.00001) (Number 4). Heterogeneities in PLT count, salivary circulation rate, and ESSDAI were eliminated after excluding one study, and significant variations were observed in these guidelines. Next, funnel plots comparing IgG level and Schirmers test result were analyzed, and no publication bias was found (Number 5). Open in a separate window Number 4 Forest plots of assessment: IGU + HCQ + GC vs. HCQ + GC, end result: ESR, RF, PLT, IgG, Schirmers test, salivary circulation rate, ESSPRI, ESSDAI, effectiveness rate, AEs. Open in a separate window Number 5 Funnel plots of assessment: IGU + HCQ + GC vs. HCQ + GC, end result: IgG, Schirmers test. IGU + GC vs. HCQ + GC In six tests that compared IGU + GC with HCQ + GC, the pooled results showed significant variations in ESR, RF level, and effectiveness rates ( 0.01) and in IgG level (= 0.06) (Number 6). However, only three studies and the excessive weightage of Yus study found the result of RF and ESR unconvincing. More studies are required. Open in a separate window Number 6 Forest plots of assessment: IGU + GC vs. HCQ + GC, end result: ESR, RF, IgG, effectiveness rate, AEs. IGU + HCQ + TGP vs. HCQ + TGP Pooled results from two tests comparing IGU + HCQ + TGP with HCQ + TGP showed significant variations in IgG level ( 0.01) and ESR (= 0.05) (Figure 7). Open in a separate window Number 7 Forest plots of assessment: IGU + HCQ + TGP vs. HCQ + TG, end result: ESR, IgG. IGU + HCQ + GC vs. LEF + HCQ + GC Only one included trial compared IGU + HCQ + GC with LEF + HCQ + GC. Pooled results showed significant improvements in ESR, RF, and IgG levels, ESSDAI, and ESSPRI in the IGU group compared to those in the LEF group. However, data from only one trial cannot be regarded as convincing evidence; consequently, more RCT tests are needed. Security of Interventions IGU + HCQ + GC vs. HCQ + GC AEs were reported in seven tests. No significant difference in the event of AEs (= 0.15) was found between IGU Vatalanib free base + HCQ + GC and HCQ + GC. Seventeen instances of gastrointestinal pain, five cases.