PMID- 36706936
OWN - NLM
STAT- MEDLINE
DCOM- 20230303
LR  - 20230303
IS  - 1872-7573 (Electronic)
IS  - 0378-8741 (Linking)
VI  - 307
DP  - 2023 May 10
TI  - Tripterygium wilfordii Hook F combination therapy with methotrexate for 
      rheumatoid arthritis: An updated meta-analysis.
PG  - 116211
LID - S0378-8741(23)00079-X [pii]
LID - 10.1016/j.jep.2023.116211 [doi]
AB  - ETHNOPHARMACOLOGICAL RELEVANCE: Rheumatoid arthritis (RA) is a chronic, systemic 
      inflammatory arthropathy. Tripterygium wilfordii Hook F (TwHF) is common herbal 
      medicine for the treatment of RA in China. However, many important issues, such 
      as efficacy, safety and optimal doses of the combination therapy of TwHF and 
      Methotrexate (MTX) for RA remain to be evaluated. AIMS OF THE STUDY: This study 
      aims to evaluate the efficacy and safety of combination therapy of TwHF and MTX 
      for RA by meta-analysis of randomized clinical trials (RCTs). MATERIAL AND 
      METHODS: Relevant literature was searched from English (PubMed, Web of Science, 
      EMBASE, and Cochrane library) and Chinese databases (WanFang, VIP, CNKI) until 
      December 2021. Response rates and rates of adverse events (AEs) were 
      independently extracted and analyzed. RESULTS: Fourteen randomized controlled 
      trials (RCTs) were included with a total of 1446 patients, which included eight 
      new RCTs with a total of 803 new patients when compared with the previous 
      meta-analysis (Wang et al., 2017). Compared to MTX monotherapy, TwHF + MTX was 
      revealed a higher effective rate (RR = 1.15, 95% CI: 1.10, 1.21), partial 
      remission rate (RR = 1.27, 95% CI: 1.15, 1.40) and remission rate (RR = 1.31, 95% 
      CI: 1.11, 1.55). The addition of TwHF benefited the clinical symptoms (such as 
      tender joint count) and most laboratory indexes (such as the tumor necrosis 
      factor-alpha). According to the subgroup analyses, the efficacy of the TwHF + MTX 
      seems to be positively associated with the dose of TwHF (10 mg/d vs 30-60 mg/d), 
      negatively related to the dose of MTX ( approximately 10 mg/w vs  approximately 15 mg/w) and methodological 
      risk of bias of included RCTs, and unrelated to the duration of therapy (12-week 
      vs 24-week). For safety, the addition of TwHF did not increase the risk of most 
      AEs and even reduced the risk of infection and liver AEs. CONCLUSION: Combining 
      TwHF with MTX may be a superior strategy in the treatment of RA compared with MTX 
      monotherapy. The optimal combination of TwHF + MTX therapy might be TwHF at 
      30-60 mg/d with MTX ( approximately 10 mg/w). Further high-quality double-blind RCTs may be 
      able to change the conclusions of our study, which are still warranted.
CI  - Copyright (c) 2023 Elsevier B.V. All rights reserved.
FAU - Luo, Yijun
AU  - Luo Y
AD  - Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of 
      Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 
      China.
FAU - Hou, Xiaoxiao
AU  - Hou X
AD  - Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of 
      Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 
      China.
FAU - Xi, Anran
AU  - Xi A
AD  - Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of 
      Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 
      China.
FAU - Luo, Mengxian
AU  - Luo M
AD  - Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of 
      Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 
      China.
FAU - Wang, Keer
AU  - Wang K
AD  - Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of 
      Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 
      China.
FAU - Xu, Zhenghao
AU  - Xu Z
AD  - Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of 
      Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 
      China. Electronic address: xuzhenghao@zcmu.edu.cn.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20230125
PL  - Ireland
TA  - J Ethnopharmacol
JT  - Journal of ethnopharmacology
JID - 7903310
RN  - YL5FZ2Y5U1 (Methotrexate)
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Plant Extracts)
SB  - IM
MH  - Humans
MH  - Methotrexate
MH  - *Antirheumatic Agents/therapeutic use
MH  - Tripterygium
MH  - *Arthritis, Rheumatoid/drug therapy
MH  - Plant Extracts/therapeutic use
MH  - Randomized Controlled Trials as Topic
OTO - NOTNLM
OT  - Meta-analysis
OT  - Methotrexate
OT  - RCTs
OT  - Rheumatoid arthritis
OT  - Tripterygium wilfordii Hook F
COIS- Declaration of competing interest We declare that we have no financial and 
      personal relationships with other people or organizations that can 
      inappropriately influence our work, there is no professional or other personal 
      interest of any nature or kind in any product, service and/or company that could 
      be construed as influencing the position presented in, or the review of, the 
      manuscript entitled, "Tripterygium wilfordii Hook F combination therapy with 
      Methotrexate for rheumatoid arthritis: An updated meta-analysis of randomized 
      clinical trials".
EDAT- 2023/01/28 06:00
MHDA- 2023/03/04 06:00
CRDT- 2023/01/27 19:24
PHST- 2022/05/12 00:00 [received]
PHST- 2022/10/24 00:00 [revised]
PHST- 2023/01/23 00:00 [accepted]
PHST- 2023/01/28 06:00 [pubmed]
PHST- 2023/03/04 06:00 [medline]
PHST- 2023/01/27 19:24 [entrez]
AID - S0378-8741(23)00079-X [pii]
AID - 10.1016/j.jep.2023.116211 [doi]
PST - ppublish
SO  - J Ethnopharmacol. 2023 May 10;307:116211. doi: 10.1016/j.jep.2023.116211. Epub 
      2023 Jan 25.