Comparative efficacy of acupuncture-related therapies for Parkinson's disease: A systematic review and network meta-analysis.

BACKGROUND

Parkinson's disease (PD) is a prevalent neurodegenerative disorder marked by progressive motor and non-motor symptoms. Although levodopa remains the standard therapy, long-term use leads to reduced efficacy and motor complications. Acupuncture-related therapies have gained attention as safe, affordable adjuncts, but the comparative effectiveness of different modalities remains uncertain.

METHOD: We conducted a comprehensive search of Chinese and international databases to identify randomized controlled trials (RCTs) evaluating the effectiveness of acupuncture-related therapies for PD. Eligible studies were selected based on predefined PICOS criteria. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the RoB 2.0 tool. A frequentist network meta-analysis was performed using Stata SE 15.1. For continuous outcomes, mean differences were calculated; for binary outcomes, risk ratios were used. A random-effects model was applied, with heterogeneity assessed by τ² and consistency tested across the network. SUCRA values were calculated to rank the comparative efficacy of interventions.

RESULT: Fifty-seven RCTs (n = 4262; 2002-2024) were included. Interventions comprised manual acupuncture (MA), electroacupuncture (EA), warm acupuncture (WA), fire acupuncture (FA), and moxibustion (MOX), used alone or in combination with conventional medication (CM) or Chinese herbal medicine (CHM). For total effective rate (41 RCTs; n = 3086), the most pronounced benefit was observed with EA + WA + CM (RR = 3.00; 95 % CI: 1.20-7.48; SUCRA = 97 %; moderate confidence). Significant improvements were also found for MOX + CM (RR = 1.33; 1.07-1.64; SUCRA = 68.8 %), MA + CM (RR = 1.20; 1.10-1.32; SUCRA = 51.7 %), and EA + CM (RR = 1.15; 1.05-1.26; SUCRA = 38.3 %). For UPDRS (36 RCTs; n = 2655), MA + CM significantly improved motor symptoms compared with CM (MD = -0.89; 95 % CI: -1.58 to -0.20; SUCRA = 61.6 %; moderate certainty). For Webster score (5 RCTs; n = 444), both EA + CM (MD = -3.65; -5.01 to -2.28; SUCRA = 91.1 %) and MA + CM (MD = -2.62; -4.31 to -0.92; SUCRA = 61.8 %) were superior to CM. For HAMD (11 RCTs; n = 802), significant reductions in depressive symptoms were observed with MA + CM (MD = -2.41; 95 % CI: -3.48 to -1.34; SUCRA = 91.9 %) and EA + CM (MD = -2.16; 95 % CI: -3.74 to -0.58; SUCRA = 62.8 %). CINeMA ratings were low to moderate for most pairwise comparisons.

CONCLUSION

Acupuncture-based therapies provided added benefits over conventional medication for Parkinson's disease. EA + WA + CM showed the most consistent improvement in overall effectiveness, MA + CM was most effective for motor symptoms, EA + CM and MA + CM demonstrated superiority for Webster scores, and MA + CM also performed best for depressive symptoms. Although the certainty of evidence ranged from low to moderate, these findings suggest that tailored combinations of acupuncture and conventional treatment may optimize outcomes in PD.