Efficacy of tripterygium glycosides for diabetic nephropathy: a meta-analysis of randomized controlled trials

Abstract

Backgrounds Diabetic nephropathy (DN) is one of the most important clinical complications of diabetes mellitus (DM) and is the most common cause of end-stage renal disease. Currently, there is no highly effective medicine that can prevent, halt, or reverse the progressive course of DN. Initial clinical data showed that Tripterygium glycosides (TGs), a traditional Chinese medicine, can decrease proteinuria in patients with DN. Objectives The objective of the present study is to investigate the efficacy and safety of TGs for the treatment of DN through meta-analysis of randomized controlled trials (RCTs). Methods All RCTs of TGs for DN were collected from The China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, Wanfang Data, Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP) by setting the study inclusion and elimination standards. Two reviewers evaluated the quality of the trials and extracted the data independently. RevMan 5.4 software was used for meta-analyses. The primary outcome was a change in 24-hours urinary total protein (24 h TUP). Results 26 RCTs with 1824 participants were identified. Studies were assessed using the Cochrane risk of bias tool. The overall effects showed that TGs was compared with the controls, TGs showed significant effects in reducing 24 h TUP [WMD = -0.84, 95 % CI (-1.09, -0.59)], elevating serum albumin [WMD = 2.88, 95 % CI (1.87, 3.90)], and the total efficiency [OR = 4.08, 95 % CI (2.37, 7.04)]. This effect was consistent across the subgroups of period of intervention. Conclusions The present research showed that TGs was significantly associated with improvement of renal function in patients with DN. TGs offers a novel approach to the treatment of DN, more high-quality RCTs are needed for a better understanding of the role of TGs in DN therapy.

Quality of Evidence Supporting the Role of Tripterygium Glycosides for the Treatment of Diabetic Kidney Disease: An Overview of Systematic Reviews and Meta-Analyses

“…A total of 8 SRs/MAs 32 , 34–36 , 38 , 40 , 41 , 43 reported on Alb, all of which were TG combined with CT versus CT alone, and the results show that combined treatment can significantly improve Alb.…”

“…There was no difference in side effects between ACEI/ARB plus TG and ACEI/ARB alone. Huabin Guo, 2021 32 26 (1824) TG + CT CT Cochrane criteria Compared with the control group, TG has a significant effect in reducing 24h-UTP, increasing serum albumin and total efficacy. In terms of adverse reactions, TG significantly reduced the white blood cells of DKD patients.…”

“…A total of 6 SRs/MAs 32 , 34 , 35 , 40–42 reported on BUN, and 5 of them were about TG combined with CT versus CT alone, but only one SR/MA 41 showed that combined treatment can reduce BUN in patients with DKD. In addition, one SR/MA 42 reported that TG can significantly reduce BUN compared with RAAS inhibitors.…”

“…A total of 5 SRs/MAs 32 , 34 , 38 , 39 , 42 reported the total clinical effective rate, of which 4 SRs/MAs 32 , 34 , 38 , 39 reported that TG combined with CT was higher than CT alone. One SR/MA 42 showed that TG was more clinically effective than RAAS inhibitors.…”

“…There are 3 SRs/MAs 34 , 35 , 43 reporting on UAER, and the results show that there was no significant difference in UAER between TG combined with CT and CT alone. Two SRs/MAs reported that TG combination therapy can significantly improve CCr 32 and Urinary β2-microglobulin in patients 34 with DKD. In addition, there was one SR/MA 35 reporting that TG combination therapy could not only reduce the inflammatory state of patients with DKD but also decrease CRP, IL6 and TNF-α.…”