title: Treatment of rheumatoid arthritis with combination of methotrexate and Tripterygium wilfordii: A meta-analysis.
abstract: OBJECTIVE
  Extracts of Tripterygium wilfordii Hook F (TwHF), a traditional Chinese herbal medicine, have been widely used for treating rheumatoid arthritis (RA) in combination with methotrexate (MTX) in China for several decades. However, the efficacy and safety of MTX plus TwHF treatment remain unclear.
  
  
  METHODS
  A comprehensive search of databases in both Chinese and English was performed. Data from the selected studies were extracted and analyzed independently by two authors.
  
  
  RESULTS
  Six randomized controlled trials were included in the final analysis with a total of 643 patients. All trials added TwHF (in the form of Tripterygium glycosides) to the MTX-based therapy. For efficacy, the addition of TwHF increased 50% responder rates (RR) (RR 1.337, 95% confidence interval [CI]: 1.188-1.505, P<0.001), and it reduced swollen and tender joint counts, shortened the duration of morning stiffness, decreased the erythrocyte sedimentation rate, and decreased the level of C-reactive protein and rheumatoid factor. For safety, the addition of TwHF did not increase the rate of adverse events (RR 0.824, 95% CI: 0.635-1.068, P=0.143).
  
  
  CONCLUSIONS
  MTX plus TwHF therapy may be a more effective and similar safe strategy for treating RA compared to MTX monotherapy. Further large clinical trials to investigate the TwHF add-on therapy are warranted.
authors.affiliation: College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Wang
authors.affiliation: College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China.
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Zu
authors.affiliation: College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Huang
authors.affiliation: College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Pharmacy, Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Huawei
authors.initials: H
authors.lastname: Zhao
authors.affiliation: College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China.
authors.forename: Chengping
authors.initials: C
authors.lastname: Wen
authors.affiliation: College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China; Department of Pharmacology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, College of Pharmaceutical Sciences, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Chen
authors.affiliation: College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China. Electronic address: xuzhenghao@zcmu.edu.cn.
authors.forename: Zhenghao
authors.initials: Z
authors.lastname: Xu
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D010936:Plant Extracts / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D029757:Tripterygium / Q000737:chemistry*
chemical_list: D018501:Antirheumatic Agents; D010936:Plant Extracts; D008727:Methotrexate
keywords: Meta-analysis; Methotrexate; Rheumatoid arthritis; Tripterygium wilfordii