A Systematic Review Of Tripterygium In Treating Idiopathic Membranous Nephropathy

ObjectiveTo assess the effectiveness and safety of Tripterygium in treating idiopathic membranous nephropathy.MethodsWe searched CBM, CNKI, VIP, WANFANG, CENTRAL, Pubmed, EMBASE and Clinical trials database for all relevant randomized controlled trials(RCTs) about Tripterygium in treating idiopathic membranous nephropathy. All the literatures were extracted by NoteExpress. The risk of bias and quality of evidences were assessed by the rule of Cochrane systematic reviews. The clinical outcomes including complete remission rate, overall response rate,24-hour urinary protein, recurrence rate, adverse reactions rate were analysed by RevMan.Results10 randomized controlled trials with 873 participants met the inclusion criteria were identified. There were 436 in experimental groups, 437 in control groups. All the RCTs were divided into difference subgroups and analysed. Compared with control groups, Tripterygium combines with ACEI/ARB have statistical differences in increasing overall response rates, complete remission rates in Low risk groups and reducing 24-hour urinary protein in the high risk groups. Tripterygium combines with immunosuppressive drugs have statistical differences in increasing overall response rates, complete remission rates in some groups (TW+GCS, TW+GCS+MMF) and reducing 24-hour urinary protein in some groups (TW+GCS, TW+FK506, TW+GCS+FK506). There were no statistical differences in overall response rates, complete remission rates and 24-hour urinary protein in some groups (TW+ARB, TW+GCS+CTX). In clinical, Tripterygium can cause liver damage, leukopenia, infection, menstrual disorders, gastrointestinal reaction and other adverse reactions. Tripterygium combines with ACEI/ARB can increase adverse reactions rates in low risk groups.But it didn’t have significant differences in adverse reactions rates and recurrence rates of other groups.ConclusionFor the low quality of RCTs, the regional of research, the difference of interventions, the difference in effect evaluation standard, the lost data on the systematic review, we can’t give a exact conclusion of the effectiveness and safety of Tripterygium in treating idiopathic membranous nephropathy. It still need more multicenter and larger randomized controlled to prove.