The Efficacy and Safety of the Combination of Total Glucosides of Peony and Leflunomide for the Treatment of Rheumatoid Arthritis: A Systemic Review and Meta-Analysis.

Zhitao Feng,Guochao He,Zhengzhi Wu,Juan Xu,Meiqun Cao,Lihong Duan,Liguo Chen

doi:10.1155/2016/9852793

Abstract

Objective. To evaluate the efficacy and safety of the total glucosides of peony (TGP) and leflunomide (LEF) for the treatment of rheumatoid arthritis (RA). Methods. Randomized controlled trials (RCTs) on the efficacy and safety of the combination of TGP and LEF versus LEF alone for the treatment of RA were retrieved by searching PubMed, EMBASE, Cochrane Library, the China National Knowledge Infrastructure database, and Wanfang database. Results. Eight RCTs including 643 RA patients were included in the present meta-analysis. The quality of included studies was poor. The levels of ESR (P < 0.0001), CRP (P < 0.0001), and RF (P < 0.0001) in RA patients who received the combination of TGP and LEF were significantly lower than RA patients who received LEF therapy alone. The pooled results suggest that the combination of TGP and LEF caused less abnormal liver function than LEF alone (P = 0.02). No significant difference in the gastrointestinal discomfort was identified between the combination of TGP and LEF and LEF alone groups (P = 0.18). Conclusion. The combination of TGP and LEF in treatment of RA presented the characteristics of notably decreasing the levels of laboratory indexes and higher safety in terms of liver function. However, this conclusion should be further investigated based on a larger sample size.

Highlights

Rheumatoid arthritis (RA) is a common chronic inflammatory disorder characterized by synovial inflammation and angiogenesis and cartilage and bone destruction [1, 2]
Studies meeting the following criteria were selected. (i) Patients were diagnosed with RA, according to the 1987 guidelines by the American Rheumatology Association. (ii) Studies were performed as a Randomized controlled trials (RCTs) describing a correct randomization procedure
Trials that used inappropriate methods of randomization were excluded. (iii) RA patients were treated with the combination of total glucosides of peony (TGP) and LEF, while controls were treated with LEF alone. (iv) Clinical outcomes included at least one of the following parameters: therapeutic effects, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C reactive protein (CRP), and side effects. (v) Intervention lasted for four weeks or longer

Summary

Introduction

Rheumatoid arthritis (RA) is a common chronic inflammatory disorder characterized by synovial inflammation and angiogenesis and cartilage and bone destruction [1, 2]. RA may cause progressive disability and a number of systemic complications, such as pulmonary, cardiovascular, psychological, and skeletal diseases [4]. It has been reported that early and sufficient application of conventional disease modifying antirheumatic drugs (DMARDs), such as leflunomide (LEF), methotrexate, sulfasalazine, hydroxychloroquine, and glucocorticoids, can effectively inhibit inflammation and bone erosion in RA patients [5]. The European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) recommend the application of DMARDs as soon as the confirmation of RA diagnosis [6].

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Results

Conclusion