Jing Luo1, Wei-Jiang Song2, Yuan Xu1, Guang-Yao Chen3, Qi Hu3, Qing-Wen Tao4. 1. Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing, 100029, China. 2. Traditional Chinese Medicine Department, Peking University Third Hospital, Beijing, 100191, China. 3. Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China. 4. Traditional Chinese Medicine Department of Rheumatism, China-Japan Friendship Hospital, Beijing, 100029, China. taoqg1@sina.com.
Abstract
OBJECTIVE: To summarize the evidence from systematic reviews (SRs) on the benefits and safety of Tripterygium glycosides (TG) and total glucosides of paeony (TGP), commonly used to treat rheumatoid arthritis (RA) in China, for patients with RA. METHODS: SRs of randomized controlled trials (RCTs) on TG or TGP in treating RA were included, by searching 8 databases from their inception until December 2017. Two authors extracted data independently. We assessed the quality of SRs using AMSTAR and graded the quality of evidence according to the GRADE approach. RESULTS: Eleven SRs containing an average of 7.6 RCTs, involving a total of 7,012 participants were included in this overview. On the basis of included SRs, TG and TGP could improve the following indexes for RA patients: American College of Rheumatology (ACR) 20 response rate, ACR50 response rate and ACR70 response rate, swollen joint count, tender joint count, erythrocyte sedimentation rate and C-reactive protein. Moreover, TGP could reduce incidence of hepatotoxicity. The most common adverse effects of TG were gastrointestinal discomfort and gonad toxicity, while for TGP was mild to moderate diarrhea. The overall quality of evidence for these findings ranged from "low" to "moderate". CONCLUSIONS: TG and TGP might be 2 potentially effective complementary and alternative drugs for patients with RA. Nevertheless, due to gonad toxicity, TG should only be considered in elderly patients or patients without reproductive needs. More evidence from high quality RCTs and SRs is warranted to support the use of TG and TGP for RA patients.
OBJECTIVE: To summarize the evidence from systematic reviews (SRs) on the benefits and safety of Tripterygium glycosides (TG) and total glucosides of paeony (TGP), commonly used to treat rheumatoid arthritis (RA) in China, for patients with RA. METHODS: SRs of randomized controlled trials (RCTs) on TG or TGP in treating RA were included, by searching 8 databases from their inception until December 2017. Two authors extracted data independently. We assessed the quality of SRs using AMSTAR and graded the quality of evidence according to the GRADE approach. RESULTS: Eleven SRs containing an average of 7.6 RCTs, involving a total of 7,012 participants were included in this overview. On the basis of included SRs, TG and TGP could improve the following indexes for RApatients: American College of Rheumatology (ACR) 20 response rate, ACR50 response rate and ACR70 response rate, swollen joint count, tender joint count, erythrocyte sedimentation rate and C-reactive protein. Moreover, TGP could reduce incidence of hepatotoxicity. The most common adverse effects of TG were gastrointestinal discomfort and gonad toxicity, while for TGP was mild to moderate diarrhea. The overall quality of evidence for these findings ranged from "low" to "moderate". CONCLUSIONS:TG and TGP might be 2 potentially effective complementary and alternative drugs for patients with RA. Nevertheless, due to gonad toxicity, TG should only be considered in elderly patients or patients without reproductive needs. More evidence from high quality RCTs and SRs is warranted to support the use of TG and TGP for RApatients.
Entities:
Keywords:
overview; rheumatoid arthritis; systematic review; total glucosides of paeony; tripterygium glycosides
Authors: Raphaela Goldbach-Mansky; Mildred Wilson; Roy Fleischmann; Nancy Olsen; Joel Silverfield; Phillip Kempf; Alan Kivitz; Yvonne Sherrer; Frank Pucino; Gyorgy Csako; Rene Costello; Tuyet Hang Pham; Christopher Snyder; Désirée van der Heijde; Xuelian Tao; Robert Wesley; Peter E Lipsky Journal: Ann Intern Med Date: 2009-08-18 Impact factor: 25.391