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Tripterygium glycosides for safely controlling disease activity in systemic lupus erythematosus: a systematic review with meta-analysis and trial sequential analysis

ABSTRACT: Background: Tripterygium glycosides have been used to treat systemic lupus erythematosus (SLE) for a long time, showing the effects of immune regulation. We aimed to evaluate the benefits and risks of Tripterygium Glycosides Tablets (TGT) for patients with SLE. Methods: We searched electronic databases and clinical trial registries for relevant randomized controlled trials (RCTs). We identified eligible RCTs and assessed risk of bias. We conducted a meta-analysis to estimate the pooled effects. The Trial Sequential Analysis (TSA) 0.9.5.10 software was used to verify the reliability of the results. Results: Eight RCTs encompassing 538 patients with SLE were included. TGT combined with conventional treatments (CTs) was superior to CTs alone in reducing lupus activity (MD = −1.66, 95% CI = −2.07 to −1.26, p < 0.00001, low-certainty evidence) and improving overall response rate (ORR) (RR = 1.21, 95% CI = 1.11 to 1.32, p < 0.0001, moderate-certainty evidence). The robustness of the results was confirmed by TSA. Regarding safety, there was no statistical difference in the overall incidence of adverse reactions between the two groups. Conclusion: In patients with SLE, TGT might safely reduce disease activity. However, further high-quality studies are needed to firmly establish the clinical efficacy of TGT. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022300474; Identifier: CRD42022300474.

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PROVIDER: S-EPMC10436586 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Project description:IntroductionSystemic lupus erythematosus (SLE) is an autoimmune disease closely related to the immune system. C1q is an important component of complement system. However, the correlation between C1q gene polymorphism and SLE has not been completely unified.AimThe primary aim of this meta-analysis was to examine the association between C1q polymorphisms and the risk of SLE.Material and methodsAll relevant articles were retrieved from PubMed, Web of Science and CNKI until June 2020. Pooled OR and 95% CI with random model were used to evaluate the strength of the association between C1q polymorphisms and SLE. Considering the limited number of studies, Trial Sequential Analysis (TSA) was applied to estimate whether the information was sufficient to make reliable and conclusive evidence. Both Egg's test and trim and fill method were performed to assess the publication bias.ResultsEight articles were included in this meta-analysis. The pooled results showed that C1q rs631090 was associated with SLE only in the homozygous and recessive model (allelic model: 1.169 (0.632-2.162), homozygous model: 2.342 (1.239-4.427), heterozygous model: 0.983 (0.395-2.448), dominant model: 1.036 (0.418-2.567), recessive model: 2.281 (1.227-4.239)) and there was no association between C1q rs172378 and rs292001 and SLE (rs172378 (allelic model: 1.071 (0.949-1.210), homozygous model: 1.172 (0.868-1.584), heterozygous model: 1.080 (0.892-1.306), dominant model: 1.100 (0.918-1.317), recessive model: 1.112 (0.863-1.431)); rs292001 (allelic model: 0.877 (0.657-1.170), homozygous model: 0.713 (0.320-1.589), heterozygous model: 0.714 (0.448-1.138), dominant model: 0.703 (0.414-1.196), recessive model: 0.927 (0.601-1.430)). Nevertheless, TSA showed that more information was needed to get more accurate results. There is no publication bias.ConclusionsThis meta-analysis suggested that C1q rs631090 but not rs172378 and rs292001 may be a potential susceptible factor associated with SLE. Nevertheless, due to the limited sample size in this meta-analysis, more large-scale association studies are still needed to confirm the results.

Project description:Background: Total glucosides of paeony (TGP), extracted from the dried roots of Paeonia lactiflora Pall., are proven to regulate immune function in various rheumatic diseases. We aim to systematically evaluate the efficacy and safety of TGP in reducing disease activity in systemic lupus erythematosus (SLE). Methods: We searched trials in seven electronic databases and two clinical trail registries. Randomized controlled trials (RCTs) evaluating efficacy and safety of TGP for SLE were identified. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment of the included trials, and RevMan 5.4 software was used for meta-analysis. Results: A total of 14 RCTs were included, including 978 participants, 492 in the intervention group and 486 in the control group. Regarding the efficacy of TGP for SLE, results showed that TGP plus conventional treatments (CTs) was superior to CTs alone in reducing disease activity (MD SLEDAI-1m = -3.54, 95% CI = -4.08 to -3.00, p < 0.00001; MD SLEDAI-2m = -3.80, 95% CI = -4.51 to -3.09, p < 0.00001; MD SLEDAI-3m = -1.62, 95% CI = -2.60 to -0.64, p < 0.0001; MD SLEDAI-6m = -1.97, 95% CI = -3.18 to -0.76, p = 0.001). The results also showed that TGP contributed to a betterment in improving other outcomes related to lupus activity, such as ESR, CRP, complement proteins (C3, C4), and immunoglobulins (IgA, IgM). In addition, TGP significantly decreased average daily glucocorticoid dosage and cumulative cyclophosamide dosage, as well as disease recurrence rate. In terms of safety, TGP may reduce the incidence of adverse reactions (RR = 0.51, 95% CI = 0.29 to 0.88, p = 0.01). The certainty of the evidence were assessed as moderate to low. Conclusion: TGP appears potentially effective and generally safe in reducing disease activity in SLE. However, in view of high risk of bias, the findings need to be confirmed in high-quality trials. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42021274850.

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Tripterygium glycosides for safely controlling disease activity in systemic lupus erythematosus: a systematic review with meta-analysis and trial sequential analysis

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