Efficacy and safety of tripterygium glycosides for Graves ophthalmopathy

Abstract

Background: Graves ophthalmopathy (GO) is one of the remaining enigmas in thyroidology. Glucocorticoids (GCs) are strongly recommended but their effects are not completely satisfactory and adverse reactions can occur. Tripterygium glycosides (TG) is a promising component extracted from Tripterygium wilfordii Hook F (TwHF), and numerous patients with GO have benefited from it. However, its practical application value is still unclear. The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of TG for patients with GO.Methods: By retrieving the PubMed, Embase, the Cochrane Library, CNKI, VIP, CBM, and WanFang Databases, the open published randomized controlled trials (RCTs) related to TG in the treatment of GO were collected. And inclusion and exclusion criteria were established. The Cochrane bias risk assessment tool conducts the evaluation of included studies, and meta-analysis was performed using Revman 5.3 software.Trial registration number: PROSPERO CRD42019131915.Results: A total of 19 trials (involving 1517 GO patients) were included in this review with generally acceptable validity of included RCTs. TG therapy brought about a significantly higher efficacy rate compared with non-TG treatments (RR: 1.40; 95% CI: 1.31-1.49). Subgroup meta-analysis showed that TG with or without immunosuppressive therapies were all better than controls: with GC (RR: 1.36; 95% CI: 1.27-1.46), with multiple intensification of immunosuppressive therapies (RR: 1.91; 95% CI: 1.37-2.67), with no immunosuppressive therapies (RR: 1.39; 95% CI:1.21-1.59); the dosage of TG for 15-60 mg/d (RR: 1.41; 95% CI: 1.30-1.53) were better compared with for ≥90 mg/d (RR: 1.47; 95% CI: 1.29-1.68); the course of treatment for 3 months (RR: 1.43; 95% CI: 1.33-1.52) was better than controls, but when >3 months (RR: 1.15; 95% CI: 0.94-1.41) there was no significant differences. After treatment, the degree of exophthalmus (SMD: À2.55; 95% CI: À2.93 to 2.17), the recurrence rate of 1 year (RR: 0.45; 95% CI: 0.27-0.74), and adverse reactions rate (RR: 0.32; 95% CI: 0.20-0.53) were all lower, while the CAS was no obvious gap in 2 groups (SMD: 0.08; 95% CI: À0.60 to 0.75).Conclusions: This review found that TG has some advantages in treating GO, especially in improving clinical efficacy and reducing adverse reactions. Nevertheless, large sample, multi-center, reasonable design, and high quality clinical studies are still needed for further verification.

Effect and safety evaluation of tacrolimus and tripterygium glycosides combined therapy in treatment of Henoch–Schönlein purpura nephritis

“…24 Previous studies have shown that tripterygium glycosides can effectively relieve the symptoms of hematuria and proteinuria in diabetic nephropathy and immunoglobulin A deposition nephropathy. 26 In the present study, we decided to use tacrolimus, a very effective immunosuppressant, and tacrolimus + tripterygium glycosides to treat children with HSPN. We showed that the therapy could effectively reduce the incidence of complications, including respiratory infection, urinary infection, poor appetite, hepatotoxicity, neutropenia and other complications, compared with traditional glucocorticoid and cyclophosphamide therapy.…”

Tripterygium glycoside improves regulatory T cells and attenuates acute organ dysfunction in septic mice

“…Due to its anti-inflammatory and immunoregulatory effects, tripterygium glycoside is used in the clinical treatment of rheumatoid arthritis, restenosis following endovascular, Graves ophthalmopathy and so on. [35][36][37] At the same time, tripterygium glycoside has many side effects included leucopenia, erythroblastopenia, granulocytopenia, nausea and so on. Therefore, tripterygium glycoside is not widely used in the clinical treatment of sepsis.…”

New Therapeutic Horizon of Graves’ Hyperthyroidism: Treatment Regimens Based on Immunology and Ingredients From Traditional Chinese Medicine

“…A systematic review included in 17 randomized controlled clinical trials with 1,536 participants showed that the serum glutamic pyruvate transaminase (SGPT) of participants slightly increased and menstrual quantity decreased during TCM treatment, but all of the aforementioned studies indicate that the occurrence rates of reported adverse effects in TCM intervention groups were fewer than controls ( Xu et al, 2014 ). Three studies reported drug-induced symptoms (such as nausea, vomiting, and gain weight), and the respondents had fewer adverse symptoms in the TCM intervention groups compared with the controls (RR: 0.32; 95% CI: 0.20–0.53; p < 0.00001; fixed model; I2 = 0%; three trials; n = 197) ( Liu et al, 2019 ). What’s more, majority of them were mild and tolerable and disappeared spontaneously after reducing the dosage of TCM or drug withdrawal.…”