Xiaoyu Wang1, Yunyun Zu1, Lin Huang1, Jie Yu1, Huawei Zhao2, Chengping Wen1, Zhong Chen3, Zhenghao Xu4. 1. College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China. 2. Department of Pharmacy, Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 3. College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China; Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, College of Pharmaceutical Sciences, School of Medicine, Zhejiang University, Hangzhou, China. 4. College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China. Electronic address: xuzhenghao@zcmu.edu.cn.
Abstract
AIMS: Extracts of Tripterygium wilfordii Hook F (TwHF), a traditional Chinese herbal medicine, have been widely used for treating rheumatoid arthritis (RA) in combination with methotrexate (MTX) in China for several decades. However, the efficacy and safety of MTX plus TwHF treatment remain unclear. MAIN METHODS: A comprehensive search of databases in both Chinese and English was performed. Data from the selected studies were extracted and analyzed independently by two authors. KEY FINDINGS: Six randomized controlled trials were included in the final analysis with a total of 643 patients. All trials added TwHF (in the form of Tripterygium glycosides) to the MTX-based therapy. For efficacy, the addition of TwHF increased 50% responder rates (RR) (RR 1.337, 95% confidence interval [CI]: 1.188-1.505, P<0.001), and it reduced swollen and tender joint counts, shortened the duration of morning stiffness, decreased the erythrocyte sedimentation rate, and decreased the level of C-reactive protein and rheumatoid factor. For safety, the addition of TwHF did not increase the rate of adverse events (RR 0.824, 95% CI: 0.635-1.068, P=0.143). SIGNIFICANCE: MTX plus TwHF therapy may be a more effective and similar safe strategy for treating RA compared to MTX monotherapy. Further large clinical trials to investigate the TwHF add-on therapy are warranted.
AIMS: Extracts of Tripterygium wilfordii Hook F (TwHF), a traditional Chinese herbal medicine, have been widely used for treating rheumatoid arthritis (RA) in combination with methotrexate (MTX) in China for several decades. However, the efficacy and safety of MTX plus TwHF treatment remain unclear. MAIN METHODS: A comprehensive search of databases in both Chinese and English was performed. Data from the selected studies were extracted and analyzed independently by two authors. KEY FINDINGS: Six randomized controlled trials were included in the final analysis with a total of 643 patients. All trials added TwHF (in the form of Tripterygium glycosides) to the MTX-based therapy. For efficacy, the addition of TwHF increased 50% responder rates (RR) (RR 1.337, 95% confidence interval [CI]: 1.188-1.505, P<0.001), and it reduced swollen and tender joint counts, shortened the duration of morning stiffness, decreased the erythrocyte sedimentation rate, and decreased the level of C-reactive protein and rheumatoid factor. For safety, the addition of TwHF did not increase the rate of adverse events (RR 0.824, 95% CI: 0.635-1.068, P=0.143). SIGNIFICANCE: MTX plus TwHF therapy may be a more effective and similar safe strategy for treating RA compared to MTX monotherapy. Further large clinical trials to investigate the TwHF add-on therapy are warranted.
Authors: Steven Dudics; David Langan; Rakeshchandra R Meka; Shivaprasad H Venkatesha; Brian M Berman; Chun-Tao Che; Kamal D Moudgil Journal: Int J Mol Sci Date: 2018-08-24 Impact factor: 5.923