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

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 Tripterygium preparations also increased the rate of complete remission by 56% (95% CI, 32%-85%; P P P Tripterygium preparations increased the rate of liver function test result abnormalities (RR, 4.03; 95% CI, 2.24-7.25; P P 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.