Efficacy of tripterygium glycosides tablet in treating ankylosing spondylitis: a systematic review and meta-analysis of randomized controlled trials

Abstract

Hundreds of randomized controlled trials (RCTs) on tripterygium glycosides tablet (TGT) in the treatment of ankylosing spondylitis (AS) have been published, but the therapeutic effects have never been systematically reviewed yet. The aim of this meta-analysis was to evaluate the efficacy of TGT on AS based on RCTs. PubMed, ScienceDirect, Cochrane Library, China Journals Full-text Database, and Wanfang Data were searched. The RCT quality was evaluated by the Cochrane Collaboration's tool for assessing risk of bias. The RCT characteristics including publication years, sample sizes, and follow-up periods as well as outcome measures including symptoms improvement, morning stiffness (MS), bath ankylosing spondylitis patient global score (BAS-G), pain index (PI), swelling index (SI), finger to floor distance (FFD), pillow wall distance (PWD), Schober test (Schober), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) were extracted. The odds ratio (OR), mean difference (MD), and its 95% confidence interval (CI) were selected for overall effect sizes. Subgroup, sensitivity, and meta-regression analyses were conducted to confirm the results. Eleven RCTs with 807 participants were included, the quality of which was moderate. OR of TGT in treating AS was 0.46 (95% CI 0.24, 0.90]. MD of MS was 11.79 (95% CI 3.13, 20.45). MD of BAS-G was 0.13 (95% CI -19.73, 19.99). MD of PI was 0.78 (95% CI 0.22, 1.34). MD of SI was 0.80 (95% CI 0.06, 1.53). MD of FFD was 0.80 (95% CI 0.06, 1.53). MD of PWD was 1.37 (95% CI -0.64, 3.38). MD of Schober was -0.36 (95% CI -0.65, -0.07]. MD of ESR was 4.58 (95% CI 2.10, 7.06). MD of CRP was 1.86 (95% CI -2.03, 5.76). Subgroup, sensitivity, and meta-regression analyses found the robust results. In conclusion, TGT could not treat AS effectively, as suggested by the moderate RCT quality and meta-analysis evidence.

Separation and simultaneous determination of seven bioactive components in Tripterygium wilfordii Hook. F. and Tripterygium preparations by micellar electrokinetic capillary chromatography

“…(TWHF), known as “lei gong teng” or “duan chang cao,” is a traditional Chinese medicine, which has been used to treat a variety of autoimmune and inflammatory diseases for decades in China . Tripterygium preparations (TPs), such as Tripterygium wilfordii tablets (TWT), Tripterygium hypoglaucum tablets (THT), and Tripterygium glycosides tablets (TGT), have been frequently used in Chinese hospitals to treat rheumatoid arthritis, systemic lupus erythematosus, and glomerulonephritis . However, the therapeutic window of most TPs is narrow.…”

Based on Network Pharmacology Tools to Investigate the Mechanism of Tripterygium wilfordii Against IgA Nephropathy

“…TwHF contains several active ingredients which affect multiple targets and pathways in the progression of IgAN and has been used as an adjuvant on IgAN treatment (11). A wide spectrum of biological activities about TwHF including anti-inflammatory, immunosuppressive, antioxidation, and antifibrosis has been demonstrated (9,(23)(24)(25)(26). Triptolide, a diterpenoid trioxide, is the most abundant and pharmacologically active of the metabolites found in TwHF extracts and is primarily responsible for the anti-inflammatory and immunosuppressive effects of TwHF preparation (27,28).…”

Efficacy and Safety of Tripterygium Wilfordii Hook. F for Connective Tissue Disease-Associated Interstitial Lung Disease:A Systematic Review and Meta-Analysis

“…Data increasingly has been showing that the related extracts of TwHF have immunomodulatory, anti-inflammatory and anti-allergic effects, and is widely used for the treatment of rheumatoid arthritis in China ( Bao and Dai, 2011 ; Bai et al, 2020 ; Hu et al, 2019 ). The results of mutiple clinical trials have demonstrated that TwHF monotherapy exhibits good efficacy in patients with active RA ( Lv et al, 2015 ), SLE ( Liu et al, 2014 ; Chen et al, 2020a ), ankylosing spondylitis ( Li et al, 2015 ; Ji et al, 2015 ), kidney disease ( Ge et al, 2013 ; Wang, 2018 )and some skin diseases, such as psoriasis ( Lv et al, 2018 ). Zhang et al found that TwHF can disrupt the process of CTD-ILD through multiple targets and multiple pathways ( Zhang et al, 2021 ).…”