title: Tripterygium preparations for the treatment of CKD: a systematic review and meta-analysis.
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.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Patients with chronic kidney disease.
  
  
  METHODS
  Randomized controlled trials.
  
  
  METHODS
  Tripterygium preparations (Tripterygium glycoside tablets, Tripterygium hypoglaucum Hutch tablets, and Tripterygium granules or extracts) versus placebo, standard care, or other immunosuppressive treatment.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhu
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.forename: Meg
authors.initials: M
authors.lastname: Jardine
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.forename: Ji-Cheng
authors.initials: JC
authors.lastname: Lv
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Thaminda
authors.initials: T
authors.lastname: Liyanage
authors.forename: Hong-Yu
authors.initials: HY
authors.lastname: Chen
authors.forename: Yong-jun
authors.initials: YJ
authors.lastname: Wang
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
mesh_terms: D006801:Humans; D010936:Plant Extracts / Q000302:isolation & purification / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D013607:Tablets; D016896:Treatment Outcome; D029757:Tripterygium
chemical_list: D010936:Plant Extracts; D013607:Tablets
keywords: Chinese herbs; Tripterygium; chronic kidney disease; glomerular disease; kidney function; meta-analysis; proteinuria; systematic review; traditional Chinese medicine