Efficacy of tripterygium glycosides combined with ARB on diabetic nephropathy: a meta-analysis.

Xue Wu,Youye Huang,Yongli Zhao,Jialin Gao,Chunling He,Lizhuo Wang,Yao Zhang

doi:10.1042/bsr20202391

Abstract

The purpose of this meta-analysis was to evaluate the beneficial and adverse effects of tripterygium glycosides (TGs) combined with angiotensin II receptor blocker (ARB) on diabetic nephropathy (DN). We searched for randomized controlled trials (RCTs) in PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Biomedical Literature Database, China Science and Technology Journal Database up to June 2017. Weighted mean difference (WMD) and standardized mean difference (SMD) were used for continuous variables and all variables were expressed by 95% confidence interval (CI). Twenty-three studies with 1810 DN patients were included in this meta-analysis. TG combined with ARB statistically significantly improved 24-h urinary total protein (24-h UTP) (SMD = −1.46; 95% CI = −1.84 to −1.09; P<0.00001), urinary albumin excretion rate (UAER) (SMD = −6.9; 95% CI = −9.65 to −4.14, P<0.00001), serum creatinine (SCr) (WMD = −7.65.14; 95% CI = −12.99 to −2.31; P=0.005) and albumin (Alb) (WMD = 5.7; 95% CI = 4.44 to 6.96; P<0.00001) more than did ARB alone. TG combined with ARB statistically significantly affected the level of serum glutamic pyruvic transaminase (SGPT) (WMD = 1.08; 95% CI = 0.04 to 2.12, P=0.04) more than did ARB alone. Compared with ARB alone, TG combined with ARB showed no significant difference in improving blood urea nitrogen (BUN) and hemoglobin A1c (HbA1c). Minor side effects from the combined treatment were observed and mainly focused on the abnormal liver function. TG combined with ARB offers a novel concept in treating DN, more high-quality RCTs are needed for better understanding and applying the combined treatment in DN.

Highlights

Diabetes mellitus (DM) is a common metabolic disease worldwide that has rapidly increased in prevalence
(2) Research subjects: patients were clinically diagnosed with Diabetic nephropathy (DN). (3) Interventions: The control group was treated with angiotensin II receptor blocker (ARB) and the experimental group was added with tripterygium glycoside (TG) on the basis of the control group
(2) Other specific types of diabetes other than type 1 DM (T1DM) and type 2 DM (T2DM). (3) Kidney damage resulting from diseases other than T1DM or T2DM. (4) Other Chinese medicines being used in the control group or the experimental group

Summary

Introduction

Diabetes mellitus (DM) is a common metabolic disease worldwide that has rapidly increased in prevalence. 2010 data showed that the prevalence of diabetes and prediabetes was 11.6 and 50.1% in a sample of Chinese adults. This means that approximately 113.9 and 493.4 million Chinese adults may suffer from diabetes and prediabetes, respectively [2]. The pathogenesis of diabetes is still not clear and there are currently no effective treatments to prevent the progression to ESRD. Clinical treatment is mainly focused on the control of blood pressure, blood glucose and inhibition of the renin–angiotensin system (RAS) [4]. In cases of DN, combined treatment using ACEI and ARB is more successful in decreasing 24-h proteinuria than ACEI alone [6]. The American Diabetes Association (ADA) recommends ARB for type 2 DN [7]

Methods

Results

Conclusion