Tripterygium preparations for the treatment of CKD: A systematic review and meta-analysis

B Zhu, Ying Wang, Meg Jardine, Min Jun, Jicheng Lv, Alan Cass, Thaminda Liyanage, Hong-Yu Chen, Wang Yong-jun, Vlado Perkovic

    Research output: Contribution to journalArticle

    Abstract

    BACKGROUND: Preparations of the herb Tripterygium wilfordii Hook F are used widely for the treatment of chronic kidney disease in China. The efficacy and safety of Tripterygium preparations still have not been fully identified.

    STUDY DESIGN:
     Systematic review and meta-analysis.

    SETTING & POPULATION:
     Patients with chronic kidney disease.

    SELECTION CRITERIA FOR STUDIES: Randomized controlled trials.

    INTERVENTION: Tripterygium preparations (Tripterygium glycoside tablets, Tripterygium hypoglaucum Hutch tablets, and Tripterygium granules or extracts) versus placebo, standard care, or other immunosuppressive treatment.

    OUTCOMES:
     Weighted mean difference and summary estimates of relative risk (RR) reductions with 95% CIs were calculated with a random-effects model. Outcomes analyzed included change in proteinuria, serum creatinine level, and creatinine clearance rate, as well as remission and relapse rate and drug-related adverse events.

    RESULTS:
     We identified 75 trials that included 4,386 participants. Overall, Tripterygium therapy reduced proteinuria by protein excretion of 628 (95% CI, -736 to -521) mg/d and reduced serum creatinine level by 0.12 (95% CI, -0.17 to -0.06) mg/dL compared with controls (both P < 0.001) in a range of kidney conditions. Tripterygium preparations also increased the rate of complete remission by 56% (95% CI, 32%-85%; P < 0.001) and of complete or partial remission by 24% (95% CI, 17%-31%; P < 0.001) while reducing relapse by 58% (95% CI, 42%-69%; P < 0.001). Tripterygium preparations increased the rate of liver function test result abnormalities (RR, 4.03; 95% CI, 2.24-7.25; P < 0.001) and altered menstruation (RR, 5.29; 95% CI, 2.09-13.38; P < 0.001).

    LIMITATIONS:
     Suboptimal study quality, significant heterogeneity in the primary outcome.

    CONCLUSIONS:
     Tripterygium preparations may have nephroprotective effects, but high-quality trials are required to reliably determine the balance of benefits and harms.
    Original languageEnglish
    Pages (from-to)515-530
    Number of pages16
    JournalAmerican Journal of Kidney Diseases
    Volume62
    Issue number3
    DOIs
    Publication statusPublished - 2013

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  • Cite this

    Zhu, B., Wang, Y., Jardine, M., Jun, M., Lv, J., Cass, A., Liyanage, T., Chen, H-Y., Yong-jun, W., & Perkovic, V. (2013). Tripterygium preparations for the treatment of CKD: A systematic review and meta-analysis. American Journal of Kidney Diseases, 62(3), 515-530. https://doi.org/10.1053/j.ajkd.2013.02.374