Journal of Traditional Chinese Medicine ›› 2022, Vol. 42 ›› Issue (5): 671-680.DOI: 10.19852/j.cnki.jtcm.2022.05.001
• Systematic Review • Next Articles
ZHOU Yingyan1, LIANG Huasheng1, YAN Jingyao1, HE Xiaohong1, PAN Lili1, LI Xue1, CHEN Xianghong1, CHEN Xiumin1, YANG Aicheng2(), HUANG Qingchun1()
Received:
2021-04-02
Accepted:
2021-07-25
Online:
2022-10-15
Published:
2022-09-02
Contact:
YANG Aicheng,HUANG Qingchun
About author:
YANG Aicheng, Department of Nephrology, Jiangmen Hospital of Chinese Medicine Affiliated to Jinan Uversity, Jiangmen 529000, China. easymu2008@163.com.Supported by:
ZHOU Yingyan, LIANG Huasheng, YAN Jingyao, HE Xiaohong, PAN Lili, LI Xue, CHEN Xianghong, CHEN Xiumin, YANG Aicheng, HUANG Qingchun. Effectiveness and safety of tripterygium glycosides tablet (雷公藤多苷片) for lupus nephritis: a systematic review and Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2022, 42(5): 671-680.
Study | Number of patients | Sex ratio (M/F) | Age (years) | Intervention and dose | Duration | Outcome | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Experimental | Control | Experimental | Control | Experimental | Control | Experimental | Control | ||||||
Wang JJ et al | 40 | 44 | 2 /38 | 2/42 | 34.2±8.7 | 32.0±10.3 | TG, 60 mg/d + GC, 10 mg/d | AZA, 2 mg·kg-1·d-1 + GC, 10 mg/d | 24 months | CR, AEs | |||
Shi F et al | 28 | 27 | 3/25 | 4/23 | 31.04±4.17 | 30.15±4.37 | TG, 60 mg/d, 10 mg/d | AZA, 1.5-4 mg·kg-1·d-1 | null | CR, PR, 24-hour urinary protein, C3, C4, Cr, AEs | |||
Dai H, Liu W | 46 | 45 | null | null | null | null | TG, 60 mg/d + GC, 5-10 mg/d | LEF, 20 mg/d + GC, 5-10 mg/d | 6 months | CR, PR, 24-hour urinary protein, C3, Cr, SLEDAI, ALB, AEs | |||
Hu XW et al | 61 | 61 | 5/56 | 1/60 | 31.5±8.1 | 27.8±8.2 | TG, 60 mg/d + GC, 10 mg/d | LEF, 20 mg/d + GC, 10 mg/d | 24 months | C3, C4, anti-dsDNA, AEs | |||
Chen GW | 27 | 26 | 3/24 | 3/23 | null | null | TG, 1-1.5 mg·kg-1·d-1, + GC 0.5 mg·kg-1·d-1 | GC 1 mg·kg-1·d-1 | 6 months | CR, PR, 24-hour urinary protein, Cr | |||
Hong L | 41 | 41 | 10/31 | 11/30 | 30.14±4. 67 | 30. 02±4. 71 | TG, 1.5 mg·kg-1·d-1, + GC, 10 mg/d | GC, 10 mg/d | 12 weeks | 24-hour urinary protein, C3, C4, anti-dsDNA | |||
Liu F et al | 31 | 31 | 3/28 | 5/26 | 37.9±3.4 | 36.6±3.5 | TG, 1.0 mg·kg-1·d-1, + GC, 1 mg·kg-1·d-1 | GC, 1 mg·kg-1·d-1 | 8 weeks | CR, PR, 24-hour urinary protein, C3, Cr, SLEDAI, ALB, Cr, AEs | |||
Du YL et al | 34 | 34 | 5/29 | 4/30 | 54.38±3.32 | 32.74±5.1 | TG, 1-1.5 mg·kg-1·d-1, + GC 0.5 mg·kg-1·d-1 | GC 1 mg·kg-1·d-1 | 6 months | CR, PR, AEs |
Table 1 Characteristics of the included trials
Study | Number of patients | Sex ratio (M/F) | Age (years) | Intervention and dose | Duration | Outcome | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Experimental | Control | Experimental | Control | Experimental | Control | Experimental | Control | ||||||
Wang JJ et al | 40 | 44 | 2 /38 | 2/42 | 34.2±8.7 | 32.0±10.3 | TG, 60 mg/d + GC, 10 mg/d | AZA, 2 mg·kg-1·d-1 + GC, 10 mg/d | 24 months | CR, AEs | |||
Shi F et al | 28 | 27 | 3/25 | 4/23 | 31.04±4.17 | 30.15±4.37 | TG, 60 mg/d, 10 mg/d | AZA, 1.5-4 mg·kg-1·d-1 | null | CR, PR, 24-hour urinary protein, C3, C4, Cr, AEs | |||
Dai H, Liu W | 46 | 45 | null | null | null | null | TG, 60 mg/d + GC, 5-10 mg/d | LEF, 20 mg/d + GC, 5-10 mg/d | 6 months | CR, PR, 24-hour urinary protein, C3, Cr, SLEDAI, ALB, AEs | |||
Hu XW et al | 61 | 61 | 5/56 | 1/60 | 31.5±8.1 | 27.8±8.2 | TG, 60 mg/d + GC, 10 mg/d | LEF, 20 mg/d + GC, 10 mg/d | 24 months | C3, C4, anti-dsDNA, AEs | |||
Chen GW | 27 | 26 | 3/24 | 3/23 | null | null | TG, 1-1.5 mg·kg-1·d-1, + GC 0.5 mg·kg-1·d-1 | GC 1 mg·kg-1·d-1 | 6 months | CR, PR, 24-hour urinary protein, Cr | |||
Hong L | 41 | 41 | 10/31 | 11/30 | 30.14±4. 67 | 30. 02±4. 71 | TG, 1.5 mg·kg-1·d-1, + GC, 10 mg/d | GC, 10 mg/d | 12 weeks | 24-hour urinary protein, C3, C4, anti-dsDNA | |||
Liu F et al | 31 | 31 | 3/28 | 5/26 | 37.9±3.4 | 36.6±3.5 | TG, 1.0 mg·kg-1·d-1, + GC, 1 mg·kg-1·d-1 | GC, 1 mg·kg-1·d-1 | 8 weeks | CR, PR, 24-hour urinary protein, C3, Cr, SLEDAI, ALB, Cr, AEs | |||
Du YL et al | 34 | 34 | 5/29 | 4/30 | 54.38±3.32 | 32.74±5.1 | TG, 1-1.5 mg·kg-1·d-1, + GC 0.5 mg·kg-1·d-1 | GC 1 mg·kg-1·d-1 | 6 months | CR, PR, AEs |
Figure 2 Risk of bias graph and summary A: risk of bias graph: judgements about each risk of bias item presented as percentages across all included studies; B: risk of bias summary: judgements about each risk of bias item for each included study. “?”: unclear risk of bias; “+”: low risk of bias; “-”: high risk of bias
Figure 3 Results of the Meta-analysis of the efficacy of TG tablet combined with GC versus GC A: forest plot of comparison of TR; B. Forest plot of comparison of CR; C: forest plot of comparison of 24-hour urinary protein; D: forest plot of comparison of C3; E: forest plot of comparison of C4; F: forest plot of comparison of serum creatinine. TG: tripterygium glycosides tablet, GC: glucocorticoids, CR: complete remission, TR: total remission [total CR plus partial remission (PR)].
Figure 4 Results of the Meta-analysis of the efficacy of TG tablet combined with GC versus AZA/LEF combined with GC A: forest plot of comparison of TR; B: forest plot of comparison of CR; C: forest plot of comparison of 24-h urinary protein; D: forest plot of comparison of C3; E: forest plot of comparison of C4; F: forest plot of comparison of serum creatinine. TG: tripterygium glycosides tablet; GC: glucocorticoids; AZA: azathioprine; LEF: leflomit; CR: complete remission; TR: total remission [total CR plus partial remission (PR)].
Therapeutic regimen | Indicator | Number of studies | Q test, P value | Model selected | RR (95% CI) | P value |
---|---|---|---|---|---|---|
TG + GC vs GC | Nausea and vomitting | 2 | 0.31 | fixed | 0.44 (0.14, 1.37) | 0.16 |
Hepatic dysfunction | 2 | 0.71 | fixed | 0.67 (0.12, 3.86) | 0.65 | |
TG vs AZA | Infection | 2 | 0.74 | fixed | 1.11 (0.72, 1.72) | 0.64 |
Irregular menstruation | 2 | 0.55 | fixed | 3.57 (1.40, 9.11) | 0.008 | |
Leucopenia | 2 | 0.40 | fixed | 0.38 (0.17, 0.85) | 0.02 | |
TG vs LEF | Infection | 2 | 0.37 | fixed | 0.49 (0.15, 1.58) | 0.23 |
Irregular menstruation | 2 | 0.49 | fixed | 6.69 (2.42, 18.46) | 0.0002 | |
Leucopenia | 2 | 0.62 | fixed | 0.50 (0.13, 1.93) | 0.31 | |
Alopecia | 2 | 0.23 | fixed | 0.14 (0.03, 0.77) | 0.02 | |
hepatic dysfunction | 2 | 0.46 | fixed | 0.69 (0.27, 1.75) | 0.44 | |
rash | 2 | 0.38 | fixed | 0.09 (0.01, 0.69) | 0.02 |
Table 2 Meta-analysis of the safety of TG tablet in treatment of patients with lupus nephritis
Therapeutic regimen | Indicator | Number of studies | Q test, P value | Model selected | RR (95% CI) | P value |
---|---|---|---|---|---|---|
TG + GC vs GC | Nausea and vomitting | 2 | 0.31 | fixed | 0.44 (0.14, 1.37) | 0.16 |
Hepatic dysfunction | 2 | 0.71 | fixed | 0.67 (0.12, 3.86) | 0.65 | |
TG vs AZA | Infection | 2 | 0.74 | fixed | 1.11 (0.72, 1.72) | 0.64 |
Irregular menstruation | 2 | 0.55 | fixed | 3.57 (1.40, 9.11) | 0.008 | |
Leucopenia | 2 | 0.40 | fixed | 0.38 (0.17, 0.85) | 0.02 | |
TG vs LEF | Infection | 2 | 0.37 | fixed | 0.49 (0.15, 1.58) | 0.23 |
Irregular menstruation | 2 | 0.49 | fixed | 6.69 (2.42, 18.46) | 0.0002 | |
Leucopenia | 2 | 0.62 | fixed | 0.50 (0.13, 1.93) | 0.31 | |
Alopecia | 2 | 0.23 | fixed | 0.14 (0.03, 0.77) | 0.02 | |
hepatic dysfunction | 2 | 0.46 | fixed | 0.69 (0.27, 1.75) | 0.44 | |
rash | 2 | 0.38 | fixed | 0.09 (0.01, 0.69) | 0.02 |
Figure 5 Results of the Meta-analysis of the safety of TG tablet combined with GC versus GC A: forest plot of comparison of hepatic dysfunction; B: forest plot of comparison of nausea and vomitting. TG: tripterygium glycosides tablet, GC: glucocorticoids.
Figure 6 Results of the Meta-analysis of the safety of TG tablet combined with GC versus AZA combined with GC A: forest plot of comparison of infection; B: forest plot of comparison of irregular menstruation; C: forest plot of comparison of leucopenia. TG: tripterygium glycosides tablet; GC: glucocorticoids; AZA: azathioprine.
Figure 7 Results of the Meta-analysis of the safety of TG tablet combined with GC versus LEF combined with GC A: forest plot of comparison of infection; B: forest plot of comparison of irregular menstruation; C: forest plot of comparison of leucopenia; D: forest plot of comparison of alopecia; E: forest plot of comparison of hepatic dysfunction; F: forest plot of comparison of rash. TG: tripterygium glycosides tablet; GC: glucocorticoids; LEF: leflomit.
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