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2023 International Consensus Guidance for the use of Tripterygium Wilfordii Hook F in the treatment of active rheumatoid arthritis.

Publication ,  Journal Article
Zhang, X; Xia, J; Jiang, Y; Pisetsky, DS; Smolen, JS; Mu, R; Dai, S; Weinblatt, ME; Kvien, TK; Li, J; Dörner, T; Zhang, Y; Lu, L; Yang, C ...
Published in: Journal of autoimmunity
November 2023

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that affects the joints and produces pain, swelling, and stiffness. It has a lifetime prevalence of up to 1% worldwide. An extract of Tripterygium wilfordii Hook F (TwHF), a member of the Celastraceae herbal family widely available in south China, has been used for treatment of RA since 1960s.The current consensus practice guidance (CPG) aims to offer guidance on the application of TwHF in the clinical management of active RA. The CPG followed World Health Organisation (WHO)'s recommended process, carried out three systematic reviews to synthesize data from 19 randomised controlled trials (RCT) involving 1795 participants. We utilized Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to evaluate certainty of evidence and derive recommendations. We rigorously followed The Appraisal of Guidelines for Research and Evaluation II (AGREE II) as conduct guides to minimise bias and promote transparency.There was no obvious difference between TwHF monotherapy and methotrexate (MTX) monotherapy on ACR20 (RCT = 2, N = 390, RR = 1.06, 95%CI 0.90-1.26, moderate certainty), ACR50 (RCT = 3, N = 419, RR = 1.03, 95%CI 0.80-1.34, moderate certainty), ACR70 (RCT = 2, N = 390, RR = 1.12, 95%CI 0.69-1.79, low certainty). TwHF monotherapy may be better than salicylazosulfapyridine monotherapy on ACR20 and the effect may be similar on ACR50 and ACR70. Seven RCTs compared MTX combined with TwHF versus MTX monotherapy, and the meta-analysis results favoured combination therapy group on ACR20 (RCT = 3, N = 470, RR = 1.44, 95%CI 1.28-1.62, moderate certainty), ACR50 (RCT = 4, N = 500, RR = 1.88, 95%CI 1.56-2.28, moderate certainty) and ACR70 (RCT = 2, N = 390, RR = 2.12, 95%CI 1.40-3.19, low certainty). We found no obvious difference between groups on critical safety outcomes, including infection (RCT = 3, N = 493, RR = 1.37, 95%CI 0.84-2.23), liver dysfunction (RCT = 5, N = 643, RR = 1.14, 95%CI 0.71-1.85), renal damage (RCT = 3, N = 450, RR = 2.20, 95%CI 0.50-9.72).Upon full review of the evidence, the guidance panel reached consensus on recommendations for the use of TwHF in people with active RA, either as monotherapy or as combination therapy with MTX.

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Published In

Journal of autoimmunity

DOI

EISSN

1095-9157

ISSN

0896-8411

Publication Date

November 2023

Volume

142

Start / End Page

103148

Related Subject Headings

  • Immunology
  • 3204 Immunology
  • 1107 Immunology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Zhang, X., Xia, J., Jiang, Y., Pisetsky, D. S., Smolen, J. S., Mu, R., … Lipsky, P. E. (2023). 2023 International Consensus Guidance for the use of Tripterygium Wilfordii Hook F in the treatment of active rheumatoid arthritis. Journal of Autoimmunity, 142, 103148. https://doi.org/10.1016/j.jaut.2023.103148
Zhang, Xuan, Jun Xia, Ying Jiang, David S. Pisetsky, Josef S. Smolen, Rong Mu, Shengming Dai, et al. “2023 International Consensus Guidance for the use of Tripterygium Wilfordii Hook F in the treatment of active rheumatoid arthritis.Journal of Autoimmunity 142 (November 2023): 103148. https://doi.org/10.1016/j.jaut.2023.103148.
Zhang X, Xia J, Jiang Y, Pisetsky DS, Smolen JS, Mu R, et al. 2023 International Consensus Guidance for the use of Tripterygium Wilfordii Hook F in the treatment of active rheumatoid arthritis. Journal of autoimmunity. 2023 Nov;142:103148.
Zhang, Xuan, et al. “2023 International Consensus Guidance for the use of Tripterygium Wilfordii Hook F in the treatment of active rheumatoid arthritis.Journal of Autoimmunity, vol. 142, Nov. 2023, p. 103148. Epmc, doi:10.1016/j.jaut.2023.103148.
Zhang X, Xia J, Jiang Y, Pisetsky DS, Smolen JS, Mu R, Dai S, Weinblatt ME, Kvien TK, Li J, Dörner T, Zhang Y, Lu L, Yang C, Yang P, Xu C, Zhao Z, Lipsky PE. 2023 International Consensus Guidance for the use of Tripterygium Wilfordii Hook F in the treatment of active rheumatoid arthritis. Journal of autoimmunity. 2023 Nov;142:103148.
Journal cover image

Published In

Journal of autoimmunity

DOI

EISSN

1095-9157

ISSN

0896-8411

Publication Date

November 2023

Volume

142

Start / End Page

103148

Related Subject Headings

  • Immunology
  • 3204 Immunology
  • 1107 Immunology