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

Abstract

Background: Total glucosides of paeony (TGP), extracted from the Chinese medicine Paeonia lactiflora Pall., have been proven to be effective in various autoimmune diseases. We aim to systematically evaluate the efficacy and safety of TGP combined with different conventional therapeutic agents in the treatment of systemic lupus erythematosus (SLE).Methods: Eight databases were searched for randomized controlled studies of TGP for SLE. The search time was set from the establishment of the databases to March 2022. The risk of bias was assessed by the Cochrane Evaluation Manual (5.1.0), RevMan 5.3 software was used for meta-analysis, and the certainty of the evidence was assessed by the GRADE methodology.Results: A total of 23 articles were included, including 792 patients overall in the treatment group and 781 patients overall in the control group. The meta-analysis results showed that TGP combined with conventional treatments was superior to the conventional treatments in reducing the SLE disease activity and the incidence of adverse reactions (SMDTGP+GC+CTX = −1.98, 95% Cl = [−2.50, −1.46], p < 0.001; SMDTGP+GC+HCQ = −0.65, 95% Cl = [−1.04, −0.26], p <0.001; SMDTGP+GC+TAC = −0.94, 95% Cl = [−1.53, -0.34], p < 0.05; SMDTGP+GC = −1.00, 95% Cl = [−1.64, −0.36], p < 0.05; and RRTGP+GC+CTX = 0.37, 95% Cl = [0.21, 0.64], p < 0.001). The results also showed that TGP helped improve other outcomes related to SLE disease activity, such as complement proteins (C3 and C4), immunoglobulins (IgA, IgM and, IgG), ESR, CRP, 24 h urine protein, and recurrence rate. In addition, TGP may also be effective in reducing the average daily dosage of glucocorticoids (GCs) and the cumulative dosage of cyclophosphamide (CTX). The certainty of the evidence was assessed as moderate to low.Conclusion: TGP is more effective and safer when used in combination with different conventional therapeutic agents. It helped reduce the disease activity of SLE and the incidence of adverse reactions. However, we should be cautious about these conclusions as the quality of the evidence is poor. Future studies should focus on improving the methodology. High-quality randomized controlled trials (RCTs) will be necessary to provide strong evidence for the efficacy of TGP for SLE.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO, identifier CRD42021272481

Efficacy and safety of total glucosides of paeony in the treatment of recurrent aphthous ulcers: a single-center, double-blind, randomized, placebo-controlled clinical trial

“…[Ranunculaceae; Paeoniae Radix Alba]. It has good immunoregulatory effects and has been widely used in the treatment of autoimmune diseases such as rheumatoid arthritis, psoriasis, systemic lupus erythematosus, and Sjogren's syndrome, demonstrating good safety (Jiang et al, 2020;Gong et al, 2022). Previous studies showed the possible mechanism of TGP in the treatment of RAU might include regulating inflammatory factors (TNF-α, IL-1β, IL-6, IL-12, TGF-β, and IL-10) (Shi et al, 2014;Giannetti et al, 2018;Zhao et al, 2018), balancing the ratio of CD4 +/CD8 + T cells (Sun et al, 2000) and Th1/Th17 cells (Kong et al, 2018), inhibiting the sensitivity of T cells to inflammation (Shi et al, 2014), and decreasing the secretion of secretory immunoglobulin A (Peng et al, 2019).…”

A Review of the Potential Benefits of Herbal Medicines, Small Molecules of Natural Sources, and Supplements for Health Promotion in Lupus Conditions

“…It could reduce the disease activity of SLE and the incidence of adverse reactions. Moreover, TGP could improve other outcomes related to SLE disease activity, including complement proteins (C3 and C4), immunoglobulins (IgA, IgM and, IgG), ESR, CRP, 24 h urine protein, and recurrence rate [117].…”

Efficacy and safety of total glucosides of paeony in the treatment of recurrent aphthous ulcers: a systematic review and meta-analysis

“…[Ranunculaceae; Paeoniae Radix Alba]. It possesses immunoregulatory properties and has been widely utilized in the treatment of autoimmune diseases ( Jiang et al, 2020 ; Gong et al, 2022 ). Based on the findings of several randomized controlled trial (RCT)-based meta-analyses ( Luo et al, 2017 ; Feng et al, 2019 ; Zheng et al, 2019 ; Wang et al, 2022 ; Yang et al, 2023 ), it is suggested that combining TGP with effective therapeutic drugs can lead to more significant treatment efficacy for Sjogren’s syndrome, systemic lupus erythematosus, psoriasis, and rheumatoid arthritis compared to using these drugs alone.…”