Combination of Oral Tripterygium Glycosides and angiotensin II receptor blockers for treatment of clinical stage diabetic kidney disease: A systematic review and meta-analysis of randomized controlled trials

Abstract

IntroductionAs the standard of care for diabetic kidney disease (DKD), angiotensin receptor blockers (ARBs) does not prevent the development of end-stage kidney disease (ESKD) in DKD patients. Tripterygium glucosides (TG) have been widely used for the treatment of various kidney diseases. The additional administration of TG to ARB may provide extra benefit for DKD patients than ARB alone. The aim of this study was to assess the evidence and evaluate the additional benefit and potential harms of TG combined with ARB for the treatment of DKD. MethodsWe comprehensively searched six electronic databases for randomized controlled trials (RCTs) with treatment of DKD with TG and ARB. All studies meeting our selection criteria were included and evaluated. Meta-analyses were conducted by using RevMan software. Results18 RCTs involving 1160 participants were included. Meta-analyses demonstrated that compared with ARB alone, TG combined with ARB provided a further beneficial therapeutic effect on clinically relevant end points including reduced urinary protein (−0.95 g/24 h, 95 %CI: −1.17 to −0.74), and improved serum albumin (3.53 g/L, 95 %CI: 2.44 to 4.62), but with higher incidence of adverse events (RR: 2.22, 95 %CI:1.32 to 3.73). ConclusionThe combination treatment of TG and ARB showed promising results regarding significant proteinuria reduction and serum albumin improvement for DKD, but with a higher risk of adverse events. Further higher-quality studies are necessary to provide solid evidence to determine a rational treatment strategy including TG, while maximizing antiproteinuric effects and minimizing adverse events for DKD patients.