ABSTRACT
Purpose
Tripterygium glycosides (TG) are widely used for the treatment of kidney disease in China. However,
the application of TG in clinical practice is limited, as the therapeutic window is
narrow, and the therapeutic dose is close to the toxic dose. In addition, the therapeutic
effect of TG combined with Western medicine has not been fully elucidated. This study
sought to explore standardized treatment, efficacy, and safety of TG combined with
Western medicine for patients with type 2 diabetic kidney disease (T2DKD).
Methods
The PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese
Biomedical Literature, Chinese Scientific Journal, and Wan Fang databases were searched
for randomized controlled trials of TG combined with Western medicine on T2DKD from
their inception until May 4, 2021. A random effects model was used to explore heterogeneity
of studies.
Findings
A total of 33 studies with 2034 patients were included in the current meta-analysis.
The findings showed that TG combined with Western medicine effectively reduced urinary
albumin excretion rates (standardized mean difference, –2.55; 95% CI, –4.70 to –0.40;
P = 0.02), 24-hour urinary protein level (mean difference, –0.79; 95% CI, –1.22 to
–0.36; P = 0.0003), and serum creatinine level (mean difference, –8.23; 95% CI, –14.48 to
–1.99; P = 0.01) and increased albumin level (mean difference, 4.70; 95% CI, 3.27 to 6.13;
P < 0.00001) in patients with T2DKD. No serious adverse reactions occurred, and the
incidence of adverse events in the TG combined with Western medicine treatment group
was slightly higher than in the control group (8.14% vs 2.65%). The results were stable,
and a significant publication bias was not detected (P > 0.05).
Implications
Based on our results, TG combined with Western medicine may be an effective and safe
therapy for T2DKD; the best treatment duration may be 3 to 6 months. Nevertheless,
larger, longer multicenter studies should be conducted for clinical application of
the regimen to patients in more countries and regions. PROSPERO registration number:
CRD42021259466.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diabetic kidney disease.Prim Care. 2020; 47: 645-659
- Chinese guidelines for diagnosis and treatment of diabetic kidney disease.Chin J Nephrol. 2021; 37: 255-304
- Diabetes control and the risks of ESRD and mortality in patients with CKD.Am J Kidney Dis. 2017; 70: 191-198
- Determinants of end-stage renal disease in Pima Indians with type 2 (non-insulin-dependent) diabetes mellitus and proteinuria.Diabetologia. 1993; 36: 1087-1093
- Reduction in microalbuminuria as an integrated indicator for renal and cardiovascular risk reduction in patients with type 2 diabetes.Diabetes. 2007; 56: 1727-1730
- Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients with left ventricular hypertrophy and diabetes.J Nephrol. 2008; 21: 566-569
- Mortality and morbidity in relation to changes in albuminuria, glucose status and systolic blood pressure: An analysis of the ONTARGET and TRANSCEND studies.Diabetologia. 2014; 57: 2019-2029
- Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy.Circulation. 2004; 110: 921-927
- Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes.J Am Soc Nephrol. 2009; 20: 1813-1821
- Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease.Nephrology (Carlton). 2020; 25: 12-45
- Addendum. 11. Microvascular complications and foot care: standards of medical care in diabetes—2021.Diabetes Care. 2021; 44: S151-S167
- KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease.Kidney Int. 2020; 98: S1-S115
- Unmet need in renal protection—do we need a more comprehensive approach?.Contrib Nephrol. 2011; 171: 157-160
- Pathophysiologic mechanisms in diabetic kidney disease: A focus on current and future therapeutic targets.Diabetes Obes Metab. 2020; 22: 16-31
- Aldosterone antagonists in addition to renin angiotensin system antagonists for preventing the progression of chronic kidney disease.Cochrane Database Syst Rev. 2020; 10CD007004
- Recent advances in traditional Chinese medicine for kidney disease.Am J Kidney Dis. 2015; 66: 513-522
- Medicinal chemistry and pharmacology of genus Tripterygium (Celastraceae).Phytochemistry. 2007; 68: 732-766
- The genus Tripterygium: A phytochemistry and pharmacological review.Fitoterapia. 2019; 137104190
- Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.BMJ. 2009; 339: b2535
- Guideline for screening, diagnosis, prevention and treatment of chronic kidney disease.Chinese Journal of Practical Internal Medicine. 2017; 37: 28-34
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928
- Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics.BMC Med Res Methodol. 2011; 11: 41
- Evaluation of the efficacy and safety of TWHF in diabetic nephropathy patients with overt proteinuria and normal eGFR.J Formos Med Assoc. 2020; 119: 685-692
- Effect of Tripterygium glycosides combined with spironolactone on subclinical hypothyroidism type 2 diabetic nephropathy.Strait Pharmaceutical J. 2020; 32: 130-131
- Effect of combination therapy with irbesartan and Tripterygium wilfordii Hook F in early stage of diabetic kidney disease.China Health Care Nutrition. 2019; 29: 246-247
- Therapeutic effect of simvastatin combined with Tripterygium on patients with diabetic nephropathy.Modern Medical J. 2018; 46: 1103-1107
- Effect of calcitriol and Tripterygium glycosides on level of TGF-β1 in patients with diabetic nephropathy (Thesis of Master Degree).Wan Nan Medical College, Wuhu, Anhui2016
- Combination of Tripterygium wilfordii Hook F and angiotensin receptor blocker synergistically reduces excretion of urinary podocytes in patients with type 2 diabetic kidney disease.Biotechnol Biotechnol Equip. 2015; 29: 139-146
- Clinical observation of low-dose Tripterygium glycosides on proteinuria in patients with diabetic nephropathy.Chinese Journal of Integrated Traditional and Western Nephrology. 2014; 15: 444-445
- Clinical efficacy of Tripterygium glycosides in the treatment of diabetic nephropathy.Journal of Clinical Medicine in Practice. 2014; 18: 114-115
- Clinical observation on Tripterygium glycosides and metformin in treating diabetic nephropathy.Western Journal of Traditional Chinese Medicine. 2014; 27: 82-84
- Tripterygium glycosides combined effect of pancreatic kininogenase in treating diabetic nephropathy.Harbin Medical Journal. 2014; 34: 97-98
- Clinical analysis of Tripterygium glycosides combined with benazepril in the treatment of diabetic nephropathy proteinuria.Journal of Bethune Medical Science. 2014; 12: 90-91
- The effects and mechanism of Tripterygium wilfordii Hook F combination with irbesartan on urinary podocyte excretion in diabetic nephropathy patients.Chin J Intern Med. 2013; 52: 469-473
- Clinical observation of Tripterygium glycosides combined with benazepril in the treatment of diabetic nephropathy.Shaanxi Journal of Traditional Chinese Medicine. 2013; 34: 1016-1017
- Effects of Tripterygium glycosides combined with fosinopril on CRP and TNF-α in early diabetic nephropathy.Chinese Journal of Integrated Traditional and Western Nephrology. 2013; 14: 1088-1089
- Clinical study of Tripterygium Glycosides combined with valsartan in the treatment of stage Ⅳ diabetic nephropathy.China Health Care & Nutrition. 2013; 9: 138
- Clinical observation of Tripterygium glycosides combined with alprostadil in the treatment of stage Ⅲ and IV diabetic nephropathy.Chinese Journal of Rural Medicine and Pharmacy. 2013; 20: 8-10
- Therapeutic effect of Tripterygium glycosides combined with irbesartan on diabetic nephropathy.China Prac Med. 2013; 8: 182-183
- Clinical observation of Tripterygium glycosides in the treatment of diabetic nephropathy.Road to Health. 2013; 12: 123
- Clinical observation of Tripterygium glycosides combined with telmisartan in the treatment of type 2 diabetic nephropathy.Chinese Medicine Modern Distance Education of China. 2013; 11: 45-46
- ARB combined with tripterygium glycosides regimen for treatment of patients with diabetic nephropathy.Journal of Clinical Medicine in Practice. 2012; 16: 112-114
- Effect of irbesartan and triptolide combination on the level of urine protein in patients with diabetic nephropathy at high altitude area.Clinical Medicine of China. 2012; 28: 1149-1151
- Tripterygium glycosides in the treatment of diabetic nephropathy.Hainan Medical Journal. 2012; 23: 31-32
- A randomized controlled trial of 1,25 (OH) 2D3 in the treatment of proteinuria in patients with diabetic nephropathy.Chinese Journal of Integrated Traditional and Western Nephrology. 2012; 13: 429-431
- Clinical observation of valsartan combined with Tripterygium glycosides in the treatment of type 2 diabetic nephropathy.Chin J Clinical Rational Drug Use. 2012; 5: 84-85
- Effect of enalapril combined with Tripterygium glycosides on urinary protein level in patients with diabetic nephropathy at high altitude.World Health Digest. 2011; 8: 34-36
- Clinical observation of Tripterygium glycosides combined with valsartan in the treatment of 46 cases of diabetic nephropathy.Chinese Journal of Integrated Traditional and Western Nephrology. 2011; 12: 811-813
- Effect of valsartan dispersible tablets combined with Tripterygium glycosides on proteinuria in patients with diabetic nephropathy.China Prac Med. 2010; 5: 156-157
- Clinical observation of Tripterygium glycosides combined with irbesartan in the treatment of massive proteinuria in patients with diabetic nephropathy.Jilin Medical Journal. 2010; 31: 5312-5313
- Effects of Tripterygium glycosides on urinary albumin and cytokines in patients with diabetic nephropathy.in: the 12th National Conference of Chinese Medicine on Diabetes, Shenyang, China2010 (August 6)
- Therapeutic effect of Tripterygium glycosides on diabetic nephropathy.Journal of China Traditional Chinese Medicine Information. 2010; 8: 37-39
- Effect of triptolide on microinflammation in the patients with diabetic nephropathy.J Clin Nephrol. 2009; 9: 82-84
- The effect of Tripterygium wilfordii on proteinuria in patients with diabetic nephropathy.Chinese Journal of Practical Internal Medicine. 2009; 29: 517-519
- Effect of triptolide on urinary monocyte chemoattractant protein-1 in patients with diabetic nephropathy.Chinese Journal of Integrated Traditional and Western Medicine. 2005; 25: 416-418
- Mechanisms and efficacy of Chinese herbal medicines in chronic kidney disease.Front Pharmacol. 2021; 11619201
- Multi-glycoside of Tripterygium wilfordii Hook. f. attenuates glomerulosclerosis in a rat model of diabetic nephropathy by exerting anti-microinflammatory effects without affecting hyperglycemia.Int J Mol Med. 2017; 40: 721-730
- Triptolide markedly attenuates albuminuria and podocyte injury in an animal model of diabetic nephropathy.Exp Ther Med. 2013; 6: 649-656
- Triptolide improves diabetic nephropathy by regulating Th cell balance and macrophage infiltration in rat models of diabetic nephropathy.Exp Clin Endocrinol Diabetes. 2016; 124: 389-398
- Triptolide restores autophagy to alleviate diabetic renal fibrosis through the miR-141-3p/PTEN/Akt/mTOR pathway.Mol Ther Nucleic Acids. 2017; 9: 48-56
- Triptolide attenuates renal tubular epithelial-mesenchymal transition via the MiR-188-5p-mediated PI3K/AKT pathway in diabetic kidney disease.Int J Biol Sci. 2018; 14: 1545-1557
- Treatment of db/db diabetic mice with triptolide: A novel therapy for diabetic nephropathy.Nephrol Dial Transplant. 2010; 25: 3539-3547
- Effect of triptolide on expression of oxidative carbonyl protein in renal cortex of rats with diabetic nephropathy.J Huazhong Univ Sci Technolog Med Sci. 2017; 37: 25-29
- Management and treatment of glomerular diseases (part 1): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.Kidney Int. 2019; 95: 268-280
- Analysis on the rationality of clinical use of Tripterygium glycosides.Chinese Traditional Patent Medicine. 2021; 43: 2597-2599
- Safety Profiles of Tripterygium wilfordii Hook F: A systematic review and meta-analysis.Front Pharmacol. 2016; 8: 402
- Efficacy of tripterygium glycosides combined with ARB on diabetic nephropathy: A meta-analysis.Biosci Rep. 2020; 40BSR20202391
- Clinical efficacy and safety of Tripterygium wilfordii Hook in the treatment of diabetic kidney disease stage IV: A meta-analysis of randomized controlled trials.Medicine (Baltimore). 2019; 98: e14604
- Clinical efficacy and safety of tripterygium glycosides in treatment of stage IV diabetic nephropathy: A meta-analysis.Open Med (Wars). 2016; 11: 611-617
Article info
Publication history
Published online: January 20, 2022
Accepted:
December 9,
2021
Identification
Copyright
© 2021 Published by Elsevier Inc.
