Treatment of rheumatoid arthritis with combination of methotrexate and Tripterygium wilfordii: A meta-analysis
Treatment of rheumatoid arthritis with combination of methotrexate and Tripterygium wilfordii: A meta-analysis
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甲氨蝶呤和雷公藤联合治疗类风湿性关节炎的荟萃分析
DOI：
10.1016/j.lfs.2017.01.004
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发表时间：
2017-02-15
期刊：
影响因子：
6.1
通讯作者：
Xu, Zhenghao
中科院分区：
文献类型：
--
作者：
Wang, Xiaoyu;Zu, Yunyun;Xu, Zhenghao
目的：雷公藤提取物是一种传统的中草药，与甲氨蝶呤（MTX）联合应用治疗类风湿关节炎（RA）已有几十年的历史。但MTX联合雷公藤多甙治疗的疗效和安全性尚不清楚。主要方法：全面检索中文和英文数据库。从选定的研究中提取数据，并由两名authentics.Key结果进行独立分析：6个随机对照试验，共643例患者被纳入最终分析。所有试验均在MTX治疗基础上添加了雷公藤多甙（以雷公藤多甙的形式）。在疗效方面，TwHF的加入增加了50%的应答率（RR）（RR 1337，95%置信区间[Cl]：1.188-1.505，P < 0.001），并减少了肿胀和压痛关节计数，缩短了晨僵时间，降低了红细胞沉降率，降低了C反应蛋白和类风湿因子水平。安全性方面，加用TwHF并未增加不良事件的发生率（RR 0.824，95%CI：0.635-1.068，P = 0.143）。意义：与MTX单药治疗相比，MTX加用TwHF治疗RA可能是一种更有效且类似安全的策略。进一步的大型临床试验，以调查TwHF添加治疗是必要的。(C)2017爱思唯尔公司All rights reserved.
Aims: Extracts of Tripterygium wilfordii Hook F (TwHF), a traditional Chinese herbal medicine, have been widely used for treating rheumatoid arthritis (RA) in combination with methotrexate (MTX) in China for several decades. However, the efficacy and safety of MTX plus TwHF treatment remain unclear.Main methods: A comprehensive search of databases in both Chinese and English was performed. Data from the selected studies were extracted and analyzed independently by two authors.Key findings: Six randomized controlled trials were included in the final analysis with a total of 643 patients. All trials added TwHF (in the form of Tripterygium glycosides) to the MTX-based therapy. For efficacy, the addition of TwHF increased 50% responder rates (RR) (RR 1337, 95% confidence interval [Cl]: 1.188-1.505, P < 0.001), and it reduced swollen and tender joint counts, shortened the duration of morning stiffness, decreased the erythrocyte sedimentation rate, and decreased the level of C-reactive protein and rheumatoid factor. For safety, the addition of TwHF did not increase the rate of adverse events (RR 0.824, 95% CI: 0.635-1.068, P = 0.143).Significance: MTX plus TwHF therapy may be a more effective and similar safe strategy for treating RA compared to MTX monotherapy. Further large clinical trials to investigate the TwHF add-on therapy are warranted. (C) 2017 Elsevier Inc. All rights reserved.