Tripterygium wilfordii Hook F versus conventional synthetic disease-modifying anti-rheumatic drugs as monotherapy for rheumatoid arthritis: a systematic review and network meta-analysis

Abstract

BackgroundTripterygium wilfordii Hook F (TwHF), a medicinal plant that has been widely used in Chinese traditional medicine, is proven effective for treating rheumatoid arthritis (RA), but its clinical efficacy and safety remain largely undefined in comparison with conventional synthetic disease modifying anti-rheumatic drugs (DMARDs).MethodsPubMed, Embase, Cochrane Library, CNKI, VIP, CBM, and WanFang Databases. Endpoints were ACR 20, 50, and 70, and the number of withdrawals due to adverse events. Initially, traditional pairwise meta-analysis was performed by using a random-effects model. Then, we performed network meta-analysis to compare different therapies by using frequentist approach.ResultsA total of 22 trials (5255 participants) were identified. By direct comparison, TwHF was superior to sulphasalazine according to ACR 20, 50 and 70. TwHF was superior to placebo according to ACR 20 and 50. By indirect comparisons, TwHF was superior to methotrexate, leflunomide, sulphasalazine, tacrolimus, minocycline and placebo according to ACR 20. Ranking by the Surface under the Cumulative Ranking curve (SUCRA) values showed that TwHF had the greatest probability for being the best treatment option according to ACR 20 (92.0 %) and ACR 50 (81.3 %), and the highest probability to be in the second (57.8 %) ranking position after leflunomide (69.6 %) according to ACR 70. By both direct and indirect comparisons, TwHF caused no more significant withdrawals than the placebo. The SUCRA values showed that TwHF had the highest probability to rank sixth (26.7 %) after the placebo (45.6 %) in causing withdrawals.ConclusionsOur data suggest that TwHF is effective and safe in the treatment of RA and has better clinical efficacy in terms of ACR 20 and 50 than existing conventional synthetic DMARDs. In the absence of head-to-head treatment comparison, the confidence in these estimates is low. Future comparative efficacy studies are warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1194-x) contains supplementary material, which is available to authorized users.

Compatibility with Panax notoginseng and Rehmannia glutinosa Alleviates the Hepatotoxicity and Nephrotoxicity of Tripterygium wilfordii via Modulating the Pharmacokinetics of Triptolide

“…Triptolide is the pivotal component of TW described as a double-edged sword. On one hand, triptolide acts as the immunosuppressant, anti-inflammatory medicine, and anti-cancer agent clinically [ 21 , 22 ]. On the other hand, triptolide results in hepatotoxicity and nephrotoxicity accompanied with the routine application [ 10 ].…”

Effect of celastrol on bone structure and mechanics in arthritic rats

“… 46 Importantly, despite the lack of a head-to-head comparison analysis, data have recently suggested that an extract of TwHF, containing celastrol, is effective and safe in the treatment of RA and might have an efficacy comparable to the existing conventional synthetic disease-modifying antirheumatic drugs, such as methotrexate. 47 …”

Natural Products for the Treatment of Autoimmune Arthritis: Their Mechanisms of Action, Targeted Delivery, and Interplay with the Host Microbiome

“…Finally, the testing of TwHF in RA patients showed that it is an efficacious form of therapy for RA both alone and in combination with conventional (mainstream) therapies such as MTX, sulfasalazine (a chemical DMARD), or other DMARDs [ 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 ]. These included randomized, placebo controlled trials as well.…”

“…One study used local application of TwHF formulation, but the rest used oral administration of TwHF. Different treatment regimen used in these studies can be summarized as follows: (a) RA patients treated with TwHF alone compared with control group that received placebo, or not [ 97 ]; (b) RA patients treated with TwHF compared with those treated with a DMARD (either MTX or sulfasalazine) [ 96 , 99 , 100 , 103 ]; and (c) RA patients treated with a combination of TwHF and MTX compared with control group that received MTX alone [ 98 , 101 , 102 ]. Taken together, the results of these studies, which also included meta-analysis, showed that TwHF alone was just as effective as either MTX or sulfasalazine alone.…”