title: Integrative therapy decreases the risk of lupus nephritis in patients with systemic lupus erythematosus: A population-based retrospective cohort study.
abstract: BACKGROUND
  Evidence on alleviating the risk of lupus nephritis by integrative therapy with conventional medicine (CM) and herbal medicine (HM) had not been addressed.
  
  
  OBJECTIVE
  We investigated the integrative effect associated the risk by a retrospective Systemic Lupus Erythematosus (SLE) cohort from Taiwan National Health Insurance Research Database (NHIRD).
  
  
  METHODS
  SLE patients with a catastrophic illness certificate (CIC) were retrospectively enrolled from the SLE cohort of the Taiwan NHIRD between 1997 and 2011. The patients were divided into an integrative medicine (IM: integrated CM plus HM) and a non-IM (CM only) group with 1:1 propensity score matching. Cox proportional regression model and the Kaplan-Meier method were conducted to estimate the hazard ratio (HR) for lupus nephritis in the cohort.
  
  
  RESULTS
  Among 16,645 newly diagnosed SLE patients holding a CIC (SLE/CIC), 1933 had received HM and 1571 had received no HM treatment. After propensity score matching, there were 273 patients with lupus nephritis-120 in the IM group and 153 in the non-IM group. The adjusted HR (0.68, 95% confidence interval [CI]: 0.54-0.87, p<0.01) for lupus nephritis was lower in the IM group than in the non-IM group. The adjusted HR (0.69, 95% CI: 0.54-0.88, p<0.001) for lupus nephritis was also lower in the group of patients who had received CM plus HM than in the group that received CM only. The core pattern of HM prescriptions, which were integrated with CM for preventing lupus nephritis, was "Sheng-Di-Huang" (raw Rehmannia glutinosa Libosch.), "Mu-Dan-Pi" (Paeonia suffruticosa Andr.), "Dan-Shan" (Salvia miltiorrhiza Bge.), "Zhi-Bo-Di-Huang-Wan.", and "Chi-Shao" (Paeoniae lactiflorae Rubra).
  
  
  CONCLUSIONS
  Integrative therapy decreased the risk of lupus nephritis among SLE patients in Taiwan. Further investigation of the pharmacological mechanism and clinical efficacy are warranted.
authors.affiliation: Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Graduate Institute of Clinical Medicine, and Graduate Institute of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Ching-Mao
authors.initials: CM
authors.lastname: Chang
authors.affiliation: Division of Rheumatology and Immunology and Department of Education, China Medical University Hospital, Taichung, Taiwan, ROC.
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Wu
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, ROC; College of Medicine, China Medical University, Taichung, Taiwan, ROC; Graduate Institute of Integrated Medicine, College of Chinese Medicine, Taichung, Taiwan, ROC.
authors.forename: Jen-Huai
authors.initials: JH
authors.lastname: Chiang
authors.affiliation: Department of Biochemistry and Molecular Biology, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medicine, Mackay Medical College, New Taipei, Taiwan, ROC.
authors.forename: Yau-Huei
authors.initials: YH
authors.lastname: Wei
authors.affiliation: Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Fang-Pey
authors.initials: FP
authors.lastname: Chen
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC; Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
authors.forename: Tai-Long
authors.initials: TL
authors.lastname: Pan
authors.affiliation: Research Center for Chinese Herbal Medicine, and School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, ROC; Departments of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan, ROC; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC. Electronic address: hungrongyen@gmail.com.
authors.forename: Hung-Rong
authors.initials: HR
authors.lastname: Yen
authors.affiliation: Research Center for Chinese Herbal Medicine, and School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, ROC; Research Center for Chinese Medicine & Acupuncture, and School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, ROC; Departments of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan, ROC. Electronic address: tcmchh55@gmail.com.
authors.forename: Hen-Hong
authors.initials: HH
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004365:Drugs, Chinese Herbal
keywords: Complementary and alternative medicine; Herbal medicine; Integrative therapy; Lupus nephritis; Systemic lupus erythematosus