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

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2023 International Consensus Guidance for the use of Tripterygium Wilfordii Hook F in the treatment of active rheumatoid arthritis
Journal of Autoimmunity ( IF 12.8 ) Pub Date : 2023-11-14 , DOI: 10.1016/j.jaut.2023.103148
Xuan Zhang ₁ , Jun Xia ₂ , Ying Jiang ₃ , David S Pisetsky ₄ , Josef S Smolen ₅ , Rong Mu ₆ , Shengming Dai ₇ , Michael E Weinblatt ₈ , Tore K Kvien ₉ , Juan Li ₁₀ , Thomas Dörner ₁₁ , Yu Zhang ₁₂ , Liwei Lu ₁₃ , Chengde Yang ₁₄ , Pingting Yang ₁₅ , Yuan Zhang ₁₆ , Chenchen Xu ₁₆ , Zhan Zhao ₁₇ , Peter E Lipsky ₁₈

Affiliation

Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo China, Ningbo, Zhejiang, China; Academic Unit of Lifespan and Population Health, School of Medicine, The University of Nottingham, Nottingham, NG7 2UH, UK.
Department of Rheumatology, Xiangya Hospital of Central South University, Changsha, China.
Duke University Medical Center, Medical Research Service, Durham Veterans Administration Medical Center, Durham, NC, USA.
Medical University of Vienna, Vienna, Austria.
Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China.
Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Brigham and Women's Hospital, Boston, MA, USA.
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Faculty of Medicine, Oslo, Norway.
Nanfang Hospital, Southern Medical University, Guangzhou, China.
Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Berlin, Germany.
Wuhan Xiehe Hospital, Huazhong University of Science and Technology School of Medicine, China.
Department of Pathology and Shenzhen Institute of Research and Innovation, The University of Hong Kong, Hongkong, China.
Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Rheumatology and Immunology, The First Hospital of China Medical University, Shenyang, China.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.
Tianjin Suyuan Evidence Based Technology Co., Ltd., China.
AMPEL BioSolutions LLC and the RILITE Research Institute, Charlottesville, VA, USA.

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.

更新日期：2023-11-14

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