Total Glucosides of Paeonia lactiflora for Safely Reducing Disease Activity in Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis

Abstract

Background: Total glucosides of paeony (TGP), extracted from the dried roots of Paeonia lactiflora Pall., are proven to regulate immune function in various rheumatic diseases. We aim to systematically evaluate the efficacy and safety of TGP in reducing disease activity in systemic lupus erythematosus (SLE).Methods: We searched trials in seven electronic databases and two clinical trail registries. Randomized controlled trials (RCTs) evaluating efficacy and safety of TGP for SLE were identified. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment of the included trials, and RevMan 5.4 software was used for meta-analysis.Results: A total of 14 RCTs were included, including 978 participants, 492 in the intervention group and 486 in the control group. Regarding the efficacy of TGP for SLE, results showed that TGP plus conventional treatments (CTs) was superior to CTs alone in reducing disease activity (MDSLEDAI-1m = −3.54, 95% CI = −4.08 to −3.00, p < 0.00001; MDSLEDAI-2m = −3.80, 95% CI = −4.51 to −3.09, p < 0.00001; MDSLEDAI-3m = −1.62, 95% CI = −2.60 to −0.64, p < 0.0001; MDSLEDAI-6m = −1.97, 95% CI = −3.18 to −0.76, p = 0.001). The results also showed that TGP contributed to a betterment in improving other outcomes related to lupus activity, such as ESR, CRP, complement proteins (C3, C4), and immunoglobulins (IgA, IgM). In addition, TGP significantly decreased average daily glucocorticoid dosage and cumulative cyclophosamide dosage, as well as disease recurrence rate. In terms of safety, TGP may reduce the incidence of adverse reactions (RR = 0.51, 95% CI = 0.29 to 0.88, p = 0.01). The certainty of the evidence were assessed as moderate to low.Conclusion: TGP appears potentially effective and generally safe in reducing disease activity in SLE. However, in view of high risk of bias, the findings need to be confirmed in high-quality trials.Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42021274850

Efficacy and safety of total glucosides of paeony in the treatment of systemic lupus erythematosus: A systematic review and meta-analysis

“…Sensitivity analysis was performed to explore the source of heterogeneity by excluding articles sequentially and reading the full text. It was found that five studies (Chen, 2013;Cai et al, 2017;Yu et al, 2019;Xiang, 2020;Xu, 2020) had a significant impact on the result. The heterogeneity was reduced after excluding the five studies (I 2 = 0%, p = 0.98).…”

“…A total of 18 studies reported SLEDAI as the primary outcome, including 598 patients overall in the experimental Twelve studies (Chen, 2013;Sun, 2013;Xu, 2015;Lin and Liu, 2016;Yang, 2016;Cai et al, 2017;Feng et al, 2017;Peng, 2018;Yu et al, 2019;Li and Zheng, 2020;Xiang, 2020;Xu, 2020) used TGP in combination with GC and CTX. One study (Zhao et al, 2020) used TGP in combination with GC and HCQ.…”

“…Ten studies reported the cumulative dosage of CTX, including 285 patients overall in the experimental group and 281 patients overall in the control group. All the ten studies (Chen, 2013;Xu, 2015;Lin and Liu, 2016;Cai et al, 2017;Feng et al, 2017;Peng, 2018;Yu et al, 2019;Li and Zheng, 2020;Xiang, 2020;Xu, 2020) used TGP in combination with GC and CTX. A random-effects model was applied for analysis because of the existence of heterogeneity (I 2 = 97%, p < 0.001).…”

“…Subgroup analysis was performed according to the different treatment drugs. Eleven studies (Chen, 2013;Xu, 2015;Lin and Liu, 2016;Yang, 2016;Cai et al, 2017;Feng et al, 2017;Peng, 2018;Yu et al, 2019;Li and Zheng, 2020;Wu et al, 2020;Xu, 2020) used TGP in combination with GC and CTX. Two studies (Xue and Lyu, 2019;Zhao et al, 2020) used TGP in combination with GC and HCQ.…”

“…To date, only one systematic review has evaluated the efficacy of TGP in different courses of treatment for SLE ( Chen et al, 2022 ). However, no study followed the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to evaluate the efficacy and safety of TGP in combination with different conventional therapeutic agents for the treatment of SLE.…”