Effects and Safety of the Tripterygium Glycoside Adjuvant Methotrexate Therapy in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

Objective. This study aimed to systematically review the efficacy and clinical safety of different courses and doses of tripterygium glycoside (TG) adjuvant methotrexate (MTX) therapy in the treatment of rheumatoid arthritis (RA). Methods. Randomized controlled trials (RCTs) of TG adjuvant MTX therapy in patients with RA were retrieved from SinoMed, China Network Knowledge Infrastructure, WanFang Data, PubMed, Cochrane Library, and Embase from inception to September 30, 2021. The effects and clinical safety evaluations were conducted using RevMan 5.3 software. Results. A total of 9 RCTs and 892 patients with RA were included in this study. In the meta-analysis, a total of 463 and 429 patients were enrolled into the TG adjuvant MTX therapy group and MTX monotherapy group, respectively. In comparison with MTX monotherapy, the results of the analyzed effects showed that the TG adjuvant MTX therapy can achieve 20%, 50%, and 70% improvements in American College of Rheumatology (ACR) criteria ACR20, ACR50, and ACR70 at P = 0.005, P = 0.0001, and P = 0.004, respectively. Simultaneously, the efficacy of the TG adjuvant MTX therapy was improved at either 30 or 60 mg/day over a six-month course compared to MTX monotherapy ( P < 0.0001). There was no statistical difference in the effects between the doses of 30 and 60 mg/day after three months ( P = 0.82). TG adjuvant MTX also reduced the expression rate of the swollen joint count, tender joint count, erythrocyte sedimentation rate, rheumatoid factor, and C-reactive protein in subgroup analyses with different courses and doses. In terms of hepatic adverse effects ( P = 0.28), leukopenia ( P = 0.78), gastrointestinal adverse effects ( P = 0.17), cutaneous adverse effects ( P = 0.94), and irregular menstruation adverse effects ( P = 0.29), there was no statistically significant difference with TG adjuvant MTX therapy and MTX monotherapy with different courses and doses. Conclusions. TG adjuvant MTX therapy is more effective than MTX monotherapy and is a safe strategy for RA treatment in doses of 30 or 60 mg/day over a treatment course of six months. However, high-quality multicenter RCT studies with large sample sizes are still needed to confirm the effects and clinical safety of different courses and doses of TG adjuvant MTX therapy.

The effectiveness and safety of lifestyle medicine and integrative therapies in inflammatory arthritis: an umbrella review using a hierarchical evidence gathering approach

“…There were 14 studies on Chinese herbal medicines, including two reviews on various Chinese herbal medicines as a pooled group ( 57 , 59 ), seven on Tripterygium willfordii Hook F extract (TwHF 2 ) (also known as leigongteng or thundergod vine) ( 51 , 53 , 56 , 60 , 63 , 64 , 66 ), and five on other specific medicines ( 52 , 54 , 55 , 61 , 62 ).…”

“…Monotherapy with TwHF extract showed an improved clinical response (ACR20) when compared with most DMARDs except cyclosporine A ( 53 ). Additionally, a combination of TwHF with methotrexate also showed improved disease activity when compared with placebo or other medications ( 56 ). With regard to other outcomes, TwHF, either as a monotherapy or a combination therapy with various DMARDs, demonstrated benefit for biomarkers, disease activity, and pain across most comparisons, although the impact on joint counts was mixed ( 51 , 56 , 60 , 63 , 66 ).…”

“…Additionally, a combination of TwHF with methotrexate also showed improved disease activity when compared with placebo or other medications ( 56 ). With regard to other outcomes, TwHF, either as a monotherapy or a combination therapy with various DMARDs, demonstrated benefit for biomarkers, disease activity, and pain across most comparisons, although the impact on joint counts was mixed ( 51 , 56 , 60 , 63 , 66 ). When compared with DMARDs, monotherapy with TwHF resulted in fewer AEs ( 63 ).…”

Efficacy and safety of Tripterygium glycosides as an add-on treatment in adults with chronic urticaria: a systematic review and meta-analysis

“… 2021 ; Geng et al. 2022 ). These results demonstrate that the incidences of liver dysfunction, amenorrhea, and leukopenia are low in the patients receiving TG, and the risks of these adverse effects are not remarkably increased along with the accumulated total dose of TG.…”

“… 2021 ; Geng et al. 2022 ). In recent years, some clinical trials have indicated that TG as an add-on treatment could improve the efficacy in comparison with H1-AH alone in adults with CU (Wei et al 2010 ; Xing and Feng 2017 ), and TG is recommended as the second-line treatment in the Chinese guideline for urticaria (CSD, CUR 2019 ).…”