Safety Profiles of Tripterygium wilfordii Hook F: A Systematic Review and Meta-Analysis

Abstract

Objective: Tripterygium wilfordii Hook F (TwHF) is a widely used and effective treatment for inflammatory diseases. There have been concerns about its toxicity but no adequate synthesis of the evidence for adverse events (AEs). We aimed to undertake a clinically informative, systematic safety profile of TwHF.Methods: We undertook a systematic review and meta-analysis of experimental studies and observational studies. We searched electronic databases and conference abstracts. Safety outcomes were rates of common AEs.Results: We screened 4137 abstracts for eligibility and included 594 studies in the analysis. The overall incidence of AEs was 26.7% (95% CI 24.8%, 28.8%) in 23,256 TwHF users. The estimates did vary markedly when stratified by specific study types. The incidence of gastrointestinal symptoms, adverse reproductive outcomes, adverse skin reactions, hematologic events and cardiovascular events were 13.3% (95% CI 11.9%, 14.9%), 11.7% (95% CI 10.3%, 13.3%), 7.8% (95% CI 6.3–9.5%), 6.5% (95% CI 5.7–7.4 %) and 4.9% (95% CI 1.6 %, 14.3 %), respectively. The prevalence of irregular menstruation (IM) was increased in patients taking TwHF compared with those given control (odds ratio [OR] 4.65, 95% CI 3.08 to 7.03). TwHF use has lower risk of weight gain (OR 0.12 [95% CI 0.04 to 0.39]) and hair loss (OR 0.37 [95% CI 0.18 to 0.78]). Furthermore, long-term aspirin use (>6 months) has a higher AEs incidence (31.0% [95% CI 24.5%–38.5%]).Conclusion: Our findings suggest that more than one in four patients who were taking TwHF had experienced AEs. A clear need exists for improved understanding of contributing risk factors, as well as of prevention and management strategies to improve patients' tolerance for TwHF.

The role of microbiome in rheumatoid arthritis treatment

“…112 However, its consumption may have potential side effects such as adverse reproductive outcomes, kidney and liver damage, cardiac damage, skin and hair disorders, weight change and even death, thus, is not recommended in countries like UK and USA. 113–115…”

Subacute combined degeneration of the spinal cord is associated with tripterygium glycoside tablet usage

“…Furthermore, tripterygium glycoside tablets lead to acute hepatic injury, myocardial damage, and gastrointestinal inflammatory changes [18,19]. Tripterygium glycoside tablets and its preparations also have obvious gastrointestinal toxicity, mainly manifested as nausea, diarrhea, and liver impairment [9]. Clinical studies have confirmed that tripterygium glycoside tablets can affect a variety of metabolic pathways, including lipid metabolism, tricarboxylic acid cycle, digestion, and absorption [20][21][22].…”

“…Both the therapeutic and toxic effects of tripterygium glycoside tablets are mediated by the same mechanisms that induce apoptosis, oxidative stress, and the release of lactate dehydrogenase [8]. A metaanalysis conducted by Chi Zhang et al showed that the main side effects of tripterygium glycoside tablets were gastrointestinal symptoms (13.3%), adverse reproductive outcomes (11.7%), skin reactions (7.8%), and hematological and cardiovascular events (6.5%) [9]. Some studies have shown that liver damage caused by tripterygium glycoside tablets has a dose-dependent relationship [10].…”

Cellular Stress-Modulating Drugs Can Potentially Be Identified by in Silico Screening with Connectivity Map (CMap)

“…For example, searching on CMap with gene expression data from tissues (liver and hypothalamus) showing diminished ER stress and improved leptin/insulin receptor signaling as query signatures successfully identified celastrol as an effective leptin sensitizer and chemical chaperone ameliorating obesity in the leptin-resistant mouse model [145]. Celastrol is a phytochemical originally extracted from the root of the thunder god vine, Tripterygium wilfordii , which has been used as a medicinal plant in China and other East Asian countries as a treatment of inflammatory diseases such as rheumatoid arthritis [145,146]. Furthermore, using the gene expression signature of celastrol as a query on CMap uncovered that withaferin A is also a chemical chaperone and a leptin sensitizer, and significantly ameliorates obesity [147].…”