Premium
The effectiveness and safety of Tripterygium wilfordii glycosides combined with disease‐modifying anti‐rheumatic drugs in the treatment of rheumatoid arthritis: A systematic review and meta‐analysis of 40 randomized controlled trials
Author(s) -
Zheng Wenhao,
Mei Yifan,
Chen Chunhui,
Cai Leyi,
Chen Hua
Publication year - 2021
Publication title -
phytotherapy research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.019
H-Index - 129
eISSN - 1099-1573
pISSN - 0951-418X
DOI - 10.1002/ptr.6996
Subject(s) - medicine , meta analysis , tripterygium wilfordii , cochrane library , rheumatoid arthritis , tripterygium , randomized controlled trial , erythrocyte sedimentation rate , adverse effect , visual analogue scale , systematic review , relative risk , physical therapy , medline , confidence interval , glycoside , alternative medicine , pathology , chemistry , organic chemistry , political science , law
Objective This systematic review and meta‐analysis were performed to investigate the efficacy and safety of Tripterygium wilfordii glycosides (TG) for rheumatoid arthritis (RA) from the current literature. Methods An electronic search was conducted in eight databases (PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese VIP Database, and Wanfang Database) from inception until September 2020. Randomized controlled trials (RCTs) with risk of bias (RoB) score ≥ 4 according to the Cochrane RoB tool were included for the analyses. The primary outcome measures were duration of morning stiffness (DMS), tender joint count (TJC), swollen joint count (SJC), visual analog score (VAS), C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF). The secondary outcome measures were the total clinical effective rate and adverse events. All the analyses were used by the random effects models. The meta‐analysis was performed using RevMan 5.3 and STATA 14.0. Results A total of 40 RCTs with 3092 patients met our inclusion criteria. This meta‐analysis showed that TG plus DMARDs for RA could decrease the DMS ( p < .001), TJC ( p < .001), SJC ( p < .001), VAS ( p < .001), serum CRP ( p < .001), ESR ( p < .001), and RF ( p < .001) and improve total effective rate ( p < .001). In addition, TG was generally safe and well tolerated in RA patients. Conclusion Despite the limitations, the present evidence supports, at least to an extent, that TG can be recommended for routine use for RA patients. More large multicenter and high‐quality RCTs are required for further research.