Tripterygium wilfordii Hook. f. Preparations for Rheumatoid Arthritis: An Overview of Systematic Reviews

Abstract

Objectives. To summarize the quantity and quality of evidence for using Tripterygium wilfordii Hook. f. (TwHF) preparations in patients with rheumatoid arthritis (RA) and to find the reasons of the disparity by comprehensively appraising the related systematic reviews (SRs). Methods. We performed an overview of evidence for the effectiveness and safety of TwHF preparations for patients with RA. We searched seven literature databases from inception to July 15, 2021. We included SRs of TwHF preparations in the treatment of RA. Four tools were used to evaluate the reporting quality, methodological quality, risk of bias, and the certainty of evidence for the included SRs, which are the PRISMA, the AMSTAR-2, the ROBIS, and the GRADE approach. Results. We included 27 SRs (with 385 studies and 33,888 participants) for this overview. The AMSTAR-2 showed that 19 SRs had critically low methodological quality and the remaining 8 had low methodological quality. The rate of overlaps was 68.31% (263/385), and the CCA (corrected covered area) was 0.53, which indicated the degree of overlap is slight. Based on the assessment of ROBIS, all 27 SRs were rated as low risk in phase 1; one SR was rated as low risk in domain 1, 9 SRs were in low risk in domain 2, 16 SRs were in low risk in domain 3, and 16 SRs were in low risk in domain 4 in phase 2; 7 SRs were rated as low risk in phase 3. Among 27 items of PRISMA, 15 items were reported over 70% of compliance, the reporting quality of 16 SRs was rated as “fair,” and 11 were “good.” Using GRADE assessment, moderate quality of evidence was found in 5 outcomes, and 5 outcomes were low quality. Conclusion. The use of TwHF preparations for the treatment of RA may be clinically effective according to the moderate-quality evidence. There are methodological issues, risk of bias, and reporting deficiencies still needed to be improved. SRs with good quality and further randomized clinical trials that focus on clinical important outcomes are needed.

The effectiveness and safety of lifestyle medicine and integrative therapies in inflammatory arthritis: an umbrella review using a hierarchical evidence gathering approach

“…There were 17 studies on Chinese herbal medicines, both as monotherapy and combination therapy with conventional pharmacotherapy, including 1 umbrella review, ( 51 ) 2 network meta-analyses, ( 52 , 53 ), and 14 meta-analyses, ( 54–67 ). Tripterygium wilfordii Hook F extract was the intervention in seven studies, with nine other studies reviewing the glucosides of paeony, specific Chinese herbal decoctions and pills, and pooled analyses of Chinese herbal medicines.…”

“…There were 14 studies on Chinese herbal medicines, including two reviews on various Chinese herbal medicines as a pooled group ( 57 , 59 ), seven on Tripterygium willfordii Hook F extract (TwHF 2 ) (also known as leigongteng or thundergod vine) ( 51 , 53 , 56 , 60 , 63 , 64 , 66 ), and five on other specific medicines ( 52 , 54 , 55 , 61 , 62 ).…”

“…Additionally, a combination of TwHF with methotrexate also showed improved disease activity when compared with placebo or other medications ( 56 ). With regard to other outcomes, TwHF, either as a monotherapy or a combination therapy with various DMARDs, demonstrated benefit for biomarkers, disease activity, and pain across most comparisons, although the impact on joint counts was mixed ( 51 , 56 , 60 , 63 , 66 ). When compared with DMARDs, monotherapy with TwHF resulted in fewer AEs ( 63 ).…”