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

Abstract

Background: Tripterygium wilfordii Hook. F (TwHF), a Chinese herbal medicine used to treat CTD-ILD patients in China, has been previously found to have immunoinhibitory, antifibrotic and anti inflammatory effects. It has also shown good results in treating autoimmune and inflammatory diseases.Objectives: This systematic review and meta-analysis aims to evaluate the efficacy and safety of TwHF for CTD-ILD.Methods: A systematic search was performed on PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, Scopus, CNKI, Wanfang, VIP, and CBM databases up to May 2021. Randomized controlled trials (RCTs) comparing TwHF plus conventional therapy versus conventional therapy alone were included. We followed the PRISMA checklist, and applied Cochrane handbook 5.1.0 and RevMan 5.3 for data analysis and quality evaluation of the included studies.Results: Based on Cochrane handbook 5.1.0, nine RCTs consisting 650 patients met the inclusion/exclusion criteria and were selected for further analysis. The obtained data showed significant improvement in lung function with TwHF plus conventional treatment compared with conventional treatment (post-treatment FVC% (MD= 8.68, 95%Cl (5.10, 12.26), p < 0.00001), FEV1% (MD = 11.24, 95%Cl (6.87, 15.61), p < 0.00001), TLC% (MD = 5.28, 95%Cl (0.69, 9.87), p = 0.02)], but no significant difference in the post-treatment DLCO% [(MD = 4.40, 95%Cl (−2.29, 11.09), p = 0.20)]. Moreover, the data showed that TwHF combined with conventional treatment significantly reduced the HRCT integral of patients [MD = -0.65, 95% (-1.01, -0.30), p = 0.0003], the level of erythrocyte sedimentation rate (MD = −9.52, 95%Cl (−11.55, −7.49), p < 0.00001), c-reactive protein (CRP) (MD = −8.42, 95%Cl (−12.47, −4.38), p < 0.0001), and rheumatoid factor (MD = −25.48, 95%Cl (−29.36, −21.60), p < 0.00001). Compared to conventional therapy, TwHF combined with conventional therapy significantly improved clinical effects (RR = 1.33, 95%Cl (1.17, 1.51), p < 0.0001), in five trials with 354 patients. In terms of improvement of symptoms and signs, the TwHF group showed a more significant improvement than the conventional treatment group (Cough (MD = −0.96, 95%Cl (−1.43, −0.50), p < 0.0001), velcro rales (MD = −0.32, 95%Cl (−0.44, −0.20), p < 0.00001), shortness of breath (MD = −1.11, 95%Cl (−1.67, −0.56), p < 0.0001)], but no statistical difference in dyspnea (MD = −0.66, 95%Cl (−1.35, 0.03), p = 0.06). There was no statistical significance in the incidence of adverse reactions.Conclusion: The performed meta-analysis indicated that TwHF combined with conventional treatment was more beneficial to patients for improving symptoms, lung function and laboratory indicators. As it included studies with relatively small sample size, the findings require confirmation by further rigorously well-designed RCTs.

Traditionelle chinesische Medizin – Relevant für die Behandlung der rheumatoiden Arthritis?

“…Tripterygium wilfordii Hook F (TwHF) ist die chinesische Arzneipflanze, welche in Deutschland als Wilfords-3-Flügelfrucht bekannt ist und zu den Spindelbaumgewächsen (Celastraceae) gehört und zur Behandlung entzündlich rheumatischer Erkrankungen in China eingesetzt wird [45]. TwHF zeigt einen anti-inflammatorischen und immunmodulierenden Effekt auf [46,47] und wurde in Studien zur RA [47][48][49], ankylosierenden Spondyloarthritis [50], Psoriasis [51,52] und interstitieller Lungenerkrankung bei Kollagenosen [53] untersucht. In China sind zwei verschiedene Extrakte von TwHF (Tripterygium-Glykosid-Tabletten und Tripterygium wilfordii-Tabletten) verfügbar und im Rahmen der staatlichen Gesundheitsversorgung zur RA-Therapie verordnungsfähig [54].…”

Safety Evaluation of Natural Drugs in Chronic Skeletal Disorders: A Literature Review of Clinical Trials in the Past 20 years

“…Natural drugs are increasingly favoured by researchers and clinicians for their lower side effects and adverse reactions ( Zeng and Jiang, 2010 ). Some natural drugs have been used to treat chronic skeletal disease since ancient times ( Chen et al, 2016 ; Li et al, 2021 ). Natural drugs can be classified according to the different CSDs they treat: 1) OP, for instance, lcariin ( Zhai et al, 2013 ; Xu et al, 2016 ; Wang Z. et al, 2017 ), D. asper Wall ex DC root ( Zhan et al, 2009 ; Su et al, 2018), resveratrol ( Wang X. et al, 2017 ; Feng et al, 2017 ; Yang et al, 2019 ), quercetin ( C. bursa-pastoris (L.) Medik ) (Zhen et al, 2018), ginsenoside ( Yang et al, 2020 ) and genistein ( Chen et al, 2018 ); and 2) OA, for instance, curcumin ( Sun et al, 2017 ), capsaicin ( Persson e t al., 2018 ), berberine ( Wong et al, 2019 ), and TwHF polyglycosides ( Lindler et al, 2020 ).…”

Proteomic Study on the Reproductive Toxicity of Tripterygium Glycosides in Rats

“…Tripterygium glycoside tablet (TGT) is the most widely used non-steroidal immunosuppressant in a clinical setting, owing to its anti-inflammatory, anti-tumor, immunosuppressive, and other effects ( Song et al, 2020 ). It is widely used in rheumatoid arthritis ( Zhang et al, 2021 ), connective tissue disease-related interstitial lung disease ( Li et al, 2021 ), IgA nephropathy ( Wang et al, 2017 ), purpura nephritis ( Wang et al, 2018 ), atopic dermatitis ( Liu et al, 2019A ), and several other autoimmune and inflammatory diseases. Our previous research has also confirmed that TGT could significantly reduce the urinary protein level of children with purpura nephritis ( Ding et al, 2019 ).…”