Abstract
Objective: To conduct a meta-analysis of the effectiveness and safety of Tripterygium wilfordii Hook. F (TwHF) extracts for the treatment of rheumatoid arthritis (RA).Methods: A systematic literature search was conducted in PubMed, EMBASE, Cochrane, Medline, CNKI, SinoMed and WanFang Library till 12 July 2017. All included studies were analyzed with the use of the Review Manager 5.2 software according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement protocol.Results: Fourteen randomized controlled trials (RCTs) were identified. TwHF extracts provided a statistically significant improvement in grip strength (GS), swelling joint count (SJC) and morning stiffness (MS) compared with placebo (P < 0.001). The meta-analysis showed significant differences between TwHF extract-treated group and the DMARDs group in GS, MS, C-reactive protein (CRP), and tender joint count (TJC) (P < 0.05), aside from ESR and SJC (P > 0.05). The pooled results also displayed significant differences between the combination of TwHF extracts with DMARDs and the DMARDs alone group in ESR, CRP, SJC, and TJC (P ≤ 0.05). For the safety analysis, two trials favored TwHF extract-treatment and one trial favored non-TWHF extract-treatment in AEs (P < 0.05). Eleven trials showed no statistically significant differences between TwHF extract-treated group and the DMARDs group (P > 0.05).Conclusions: The findings of this systematic review with meta-analysis indicate that TwHF extracts provides statistically significant and clinically important improvement in RA symptoms and has an acceptable safety profile.
Highlights
Rheumatoid arthritis (RA) is an autoimmune disease of still unknown etiology that is characterized by systemic, destructive, and progressive inflammatory polyarthritis (Smolen et al, 2016)
Biologics are unlikely to be of general benefit in the developing world because of the financial constraints (Hodkinson et al, 2014) costs are decreasing as several original drugs are subject for competition with recent biosimilars Tripterygium wilfordii Hook F (TwHF) is a member of the Celastraceae family and is abundant in south China (Tao and Lipsky, 2000)
According to the selection criteria defined in the Methods section, 14 RCTs were included for systematic review and 14 RCTs were included in the meta-analysis
Summary
Rheumatoid arthritis (RA) is an autoimmune disease of still unknown etiology that is characterized by systemic, destructive, and progressive inflammatory polyarthritis (Smolen et al, 2016). The potential molecular mechanisms underlying the anti-inflammatory and immunosuppressive effects of TwHF extracts includes the inhibition of platelet activation (Hu et al, 2009), nitric oxide induction (Wang et al, 2004), as well as prostaglandin E2 production (Geng et al, 2012). Based on studies both in vitro and in vivo, it is reasonable to speculate that TwHF extracts represent herbal DMARDs, which is different from synthetic DMARDs. Importantly, TwHF extracts have been listed in the Clinical Guidelines for diagnosis and treatment of RA in China since 2004
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