The effectiveness and safety of Tripterygium wilfordii Hook. F. for patients with chronic kidney disease: an overview of systematic reviews

IF 1.7 4区医学 Q3 INTEGRATIVE & COMPLEMENTARY MEDICINE

European Journal of Integrative Medicine Pub Date : 2025-09-05 DOI:10.1016/j.eujim.2025.102551

Chen-pei Liu , Yang-yang Lei , Yue-qi Zhang , Bang-tai Cao , Xiao-han Bian , Hui-min Liang , Tran Anh Kieu , Thomas John Osilama , Ogbe Susan Enechojo , Yan Lin

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引用次数: 0

Abstract

Introduction

Many systematic reviews (SRs)/meta-analyses (MAs) have explored the effectiveness and safety of Tripterygium wilfordii Hook. F. (TwHF) for chronic kidney disease (CKD), yet findings remain inconsistent, and their quality has not been adequately assessed. We aimed to identify these SRs/MAs and assess their evidence level.

Methods

We conducted a comprehensive literature search across eight databases up to December 13, 2024. For each included SR/MA, we used A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR2), the Risk of Bias in Systematic Reviews tool (ROBIS), and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess methodological quality, risk of bias, and evidence certainty, respectively.

Results

A total of 32 SRs/MAs were analyzed. The AMSTAR 2 checklist showed that the methodological quality of all the included SRs/MAs was very low. The ROBIS tool suggested that 8 SRs/MAs were assessed as having low overall risk of bias, while the remaining were assessed as having high overall risk of bias. High-quality evidence from GRADE suggested that in nephrotic syndrome patients, the combination of TwHF and prednisone significantly increased the effectiveness rate (OR=3.37, 95 %CI: 1.99–5.17; N=10; I²=30 %), reduced recurrence rate (OR=0.34, 95 %CI: 0.20–0.57; N=6; I²=34 %), decreased 24-hour urinary total protein (MD=-0.98, 95 %CI: -1.27 to -0.70; N=8; I²=56 %), and improved serum albumin levels (MD=0.79, 95 %CI: 0.44–1.14; N=8; I²=39 %) compared to prednisone alone. In addition, 18 pieces of moderate-quality evidence with GRADE assessment were found, which indicated that the combination of TwHF and prednisone significantly reduced the incidence of both gastrointestinal adverse events (OR=0.49; 95 % CI: 0.29 to 0.83; N=4; I²=0 %) and leukopenia (OR=0.37; 95 % CI: 0.18 to 0.75; N=6; I²=0 %) compared to prednisone monotherapy. However, combining TwHF with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) significantly increased adverse event incidence compared to ACEI/ARB alone.

Conclusion

TwHF may potentially improve treatment outcomes in patients with CKD. Conclusions regarding both effectiveness and safety are only meaningful when confined to specific CKD subgroups and treatment comparisons. Furthermore, due to substantial heterogeneity and generally low methodological quality, the findings of this study should be interpreted with caution.

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雷公藤的有效性和安全性。慢性肾病患者：系统综述

许多系统综述(SRs)/荟萃分析（MAs）已经探讨了雷公藤的有效性和安全性。F. （TwHF）用于慢性肾脏疾病（CKD），但结果仍不一致，其质量尚未得到充分评估。我们的目的是识别这些sr / ma并评估其证据水平。方法对截至2024年12月13日的8个数据库进行全面的文献检索。对于每一个纳入的SR/MA，我们分别使用A MeaSurement Tool to Assessment Systematic Reviews 2 （AMSTAR2）、Risk of Bias in Systematic Reviews （ROBIS）和Grading of Recommendations Assessment， Development and Evaluation （GRADE）来评估方法学质量、Risk of Bias和evidence确定性。结果共分析了32例SRs/MAs。AMSTAR 2检查表显示所有纳入的SRs/ ma的方法学质量都很低。ROBIS工具显示8例SRs/MAs被评估为具有低总体偏倚风险，而其余的被评估为具有高总体偏倚风险。来自GRADE的高质量证据表明，在肾病综合征患者中，与单用强的松相比，TwHF联合强的松显著提高了治愈率（OR=3.37, 95% CI: 1.99-5.17； N=10; I²= 30%），降低了复发率（OR=0.34, 95% CI: 0.20-0.57； N=6; I²= 34%），降低了24小时尿总蛋白（MD=-0.98, 95% CI: -1.27 - -0.70； N=8; I²= 56%），改善了血清白蛋白水平（MD=0.79, 95% CI: 0.44-1.14； N=8; I²= 39%）。此外，我们还发现了18个中等质量的GRADE评估证据，这些证据表明，与强的松单药治疗相比，TwHF和强的松联合治疗显著降低了胃肠道不良事件（OR=0.49; 95% CI: 0.29至0.83；N=4; I²= 0%）和白细胞减少（OR=0.37; 95% CI: 0.18至0.75；N=6; I²= 0%）的发生率。然而，与单独使用ACEI/ARB相比，TwHF与血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）联合使用显著增加了不良事件的发生率。结论twhf可能改善CKD患者的治疗效果。关于有效性和安全性的结论仅在仅限于特定CKD亚组和治疗比较时才有意义。此外，由于大量的异质性和普遍较低的方法学质量，本研究的结果应谨慎解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Integrative Medicine INTEGRATIVE & COMPLEMENTARY MEDICINE-

CiteScore

4.70

自引率

4.00%

发文量

102

审稿时长

33 days

期刊介绍： The European Journal of Integrative Medicine (EuJIM) considers manuscripts from a wide range of complementary and integrative health care disciplines, with a particular focus on whole systems approaches, public health, self management and traditional medical systems. The journal strives to connect conventional medicine and evidence based complementary medicine. We encourage submissions reporting research with relevance for integrative clinical practice and interprofessional education. EuJIM aims to be of interest to both conventional and integrative audiences, including healthcare practitioners, researchers, health care organisations, educationalists, and all those who seek objective and critical information on integrative medicine. To achieve this aim EuJIM provides an innovative international and interdisciplinary platform linking researchers and clinicians. The journal focuses primarily on original research articles including systematic reviews, randomized controlled trials, other clinical studies, qualitative, observational and epidemiological studies. In addition we welcome short reviews, opinion articles and contributions relating to health services and policy, health economics and psychology.