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      Ivy leaf ( Hedera helix) for acute upper respiratory tract infections: an updated systematic review

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          Abstract

          Purpose

          Acute cough due to viral upper respiratory tract infections (URTIs) and bronchitis is a common reason for patients to seek medical care. Non-antibiotic over-the-counter cough medications such as ivy leaf extract are frequently used but their efficacy is uncertain. Our purpose was to update our previous systematic review and evaluate the effectiveness and tolerability of ivy leaf in the treatment of acute URTIs in adult and pediatric populations.

          Methods

          We searched MEDLINE, EMBASE, the Cochrane Library, and clinical trial registries from December 2009 to January 2020. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and observational studies (OSs) investigating ivy leaf mono- or combination preparations were included. Two independent reviewers assessed records for eligibility and risk of bias and performed data extraction.

          Results

          Six RCTs, 1 CCT, and 4 OSs were identified. Since the publication of our previous review, the number of RCTs has increased. All studies concluded that ivy leaf extract is an effective and safe option for the treatment of cough due to URTIs and bronchitis. Three RCTs reported a more rapid reduction in cough severity and/or frequency under ivy leaf treatment. The clinical significance of these effects appears to be minimal. No serious adverse effects were reported. The overall quality of reporting was low and the risk of bias was high.

          Conclusions

          Ivy leaf preparations are safe for use in cough due to acute URTIs and bronchitis. However, effects are minimal at best and of uncertain clinical importance.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00228-021-03090-4.

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          Most cited references32

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          RoB 2: a revised tool for assessing risk of bias in randomised trials

          Jonathan A C Sterne, Jelena Savović, Matthew J L Page … (2022)
          Article 0 comments Cited 6423 times – based on 0 reviews     Review now
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            ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

            Jonathan AC Sterne, Miguel A. Hernán, Barnaby Reeves … (2018)
            Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.
            Article 0 comments Cited 4099 times – based on 0 reviews     Review now
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              Pharmaceutical industry sponsorship and research outcome and quality: systematic review.

              Joel Lexchin, Lisa Bero, Benjamin Djulbegovic … (2003)
              To investigate whether funding of drug studies by the pharmaceutical industry is associated with outcomes that are favourable to the funder and whether the methods of trials funded by pharmaceutical companies differ from the methods in trials with other sources of support. Medline (January 1966 to December 2002) and Embase (January 1980 to December 2002) searches were supplemented with material identified in the references and in the authors' personal files. Data were independently abstracted by three of the authors and disagreements were resolved by consensus. 30 studies were included. Research funded by drug companies was less likely to be published than research funded by other sources. Studies sponsored by pharmaceutical companies were more likely to have outcomes favouring the sponsor than were studies with other sponsors (odds ratio 4.05; 95% confidence interval 2.98 to 5.51; 18 comparisons). None of the 13 studies that analysed methods reported that studies funded by industry was of poorer quality. Systematic bias favours products which are made by the company funding the research. Explanations include the selection of an inappropriate comparator to the product being investigated and publication bias.
              Article 0 comments Cited 471 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Elizabeth Sierocinski:
                ORCID: http://orcid.org/0000-0003-3679-671X
                elizabeth.sierocinski@med.uni-greifswald.de
                Journal
                Journal ID (nlm-ta): Eur J Clin Pharmacol
                Journal ID (iso-abbrev): Eur J Clin Pharmacol
                Title: European Journal of Clinical Pharmacology
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0031-6970
                ISSN (Electronic): 1432-1041
                Publication date (Electronic): 1 February 2021
                Publication date PMC-release: 1 February 2021
                Publication date (Print): 2021
                Volume: 77
                Issue: 8
                Pages: 1113-1122
                Affiliations
                [1 ]GRID grid.412469.c, ISNI 0000 0000 9116 8976, Department of General Practice, Institute for Community Medicine, , Universitätsmedizin Greifswald, ; Greifswald, Germany
                [2 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of General Practice, , Charité – Universitätsmedizin Berlin, ; Berlin, Germany
                Author information
                http://orcid.org/0000-0003-3679-671X
                https://orcid.org/0000-0002-8400-7757
                https://orcid.org/0000-0001-8877-2950
                Article
                Publisher ID: 3090
                DOI: 10.1007/s00228-021-03090-4
                PMC ID: 8275562
                PubMed ID: 33523253
                SO-VID: 67ca4c34-f0ff-4f9e-9d2d-87f79b1feb53
                Copyright © © The Author(s) 2021
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 30 July 2020
                Date accepted : 13 January 2021
                Funding
                Funded by: Projekt DEAL
                Open Access :

                Open Access funding enabled and organized by Projekt DEAL.

                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine
                Keywords: acute cough,bronchitis,ivy leaf extract,hedera helix
                Data availability:
                ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine
                Keywords: acute cough, bronchitis, ivy leaf extract, hedera helix

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