A Systematic Review and Network Meta-Analysis about the Efficacy and Safety of Tripterygium wilfordii Hook F in Rheumatoid Arthritis

Abstract

Objective. This study aims to evaluate the efficacy of various conventional synthetic DMARDs, including Tripterygium wilfordii Hook F (TwHF) for treating rheumatoid arthritis (RA) by network meta-analysis. Methods. We retrieved the related literature from online databases and supplemented it by using a manual retrieval method. Data was extracted from the literature and analyzed with STATA software. Results. A total of 21 trials (5,039 participants) were identified. Assessment of ACR20 response found that TwHF combined with methotrexate (MTX) had the greatest probability for being the best treatment option among the treatments involved, while TwHF used singly was second only to TwHF combined with MTX. Assessment of ACR50 response found that TwHF combined with MTX ranked second in all treatment options after cyclosporine A (CsA) combined with leflunomide (LEF) and TwHF alone, followed by TwHF combined with MTX. Assessment of ACR70 response found that CsA combined with LEF ranked first, TwHF combined with LEF ranked second, TwHF combined with MTX ranked third, and TwHF used singly ranked fourth. In the safety analysis, TwHF had the least probability of adverse event occurrence, followed by TwHF combined with MTX, which ranked first and second, respectively. Conclusion. Compared with the current csDMARDs for treating RA, the efficacy of TwHF was clear, and TwHF combined with MTX performed well under various endpoints. In the future, large, rigorous, and high-quality RCTs are still needed to confirm the benefits of TwHF therapy on RA.

Long noncoding RNA/circular RNA regulates competitive endogenous RNA networks in rheumatoid arthritis: molecular mechanisms and traditional Chinese medicine therapeutic significances

“…Tripterygium wilfordii Hook.f., also called Leigongteng in TCM, is a commonly used anti-rheumatic herbal drug [ 137 ]. Triptolide (TPL) is a diterpene lactone epoxide compound extracted from Tripterygium , and it possesses diverse biological profiles, such as anti-fertility, anti-tumour, anti-inflammatory, as well as immunosuppressive activities [ 138 , 139 ].…”

A comprehensive review of Tripterygium wilfordii hook. f. in the treatment of rheumatic and autoimmune diseases: Bioactive compounds, mechanisms of action, and future directions

“…Similarly, a further systematic review and network meta-analysis evaluating the efficacy and safety of T. wilfordii in treating RA found that the glycosides of this plant administered in combination with MTX may have been the optimal treatment of choice based on an assessment of the ACR20 response. Moreover, among the different treatments assessed, the use of T. wilfordii glycosides alone ranked second only to the T. wilfordii glycoside + MTX combined treatment (Wang et al, 2022).…”

Using herbs medically without knowing their composition: are we playing Russian roulette?

“…More randomized clinical trials of better quality have been published, showing beneficial effects of herbal medications in conditions such as diabetes mellitus 47 , hypertension 48 , reduction in proteinuria and renal function decline [49][50][51] . A number of meta-analyses published in recent years evaluated the effects of herbal medicine in different medical conditions, including bronchiolitis in infants 52 , psoriasis 53 , rheumatoid arthritis 54 , and irritable bowel syndrome 55 . While the herbal medicines appear to be safe, the available evidence in the literature does not appear to be sufficient or vigorous enough to confirm their benefits 53,55 .…”