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Published in: Trials 1/2016

Open Access 01-12-2016 | Research

Kunxian capsules in the treatment of patients with ankylosing spondylitis: a randomized placebo-controlled clinical trial

Authors: Qiuxia Li, Li Li, Liqi Bi, Changhong Xiao, Zhiming Lin, Shuangyan Cao, Zetao Liao, Jieruo Gu

Published in: Trials | Issue 1/2016

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Abstract

Background

Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease. Kunxian capsule, a Chinese patent medicine which has been used in the treatment of immunologic diseases for many years in China, has anti-inflammatory and immunoregulatory effects. This study investigates the efficacy and safety of Kunxian capsules in the treatment of AS.

Method

This was a randomized, double-blind, parallel control clinical trial involving 80 patients with AS who fulfilled the modified New York criteria (1984) and had active disease defined by a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥40 mm under background stable nonsteroidal anti-inflammatory drugs (NSAIDs) for more than 4 weeks. Patients were randomly divided into two groups, the Kunxian group and the placebo group, and Kunxian (0.6 g, three times per day) and the placebo were provided for 12 weeks. The primary endpoint was the Assessment of SpondyloArthritis international Society (ASAS) 20 response rate at week 12. The secondary endpoints were ASAS 40, BASDAI 50, the Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Ankylosing Spondylitis Disease Activity Score on the basis of C-reactive protein level (ASDAS-CRP) at weeks 2, 6, and 12.

Results

The primary endpoint of ASAS 20 at week 12 was achieved in 13 of 35 patients (37.1 %) among the Kunxian group, compared with 4 of 33 (12.1 %) in the placebo group (p < 0.05). Significant improvement (BASDAI 50) was also observed between the Kunxian group and the placebo group at week 6 (14 (40 %) and 5 (15.5 %), respectively, p < 0.05). At weeks 2, 6, and 12, the ASDAS-CRP level of the Kunxian group was significantly lower than that of the placebo group, especially at week 6 (p < 0.01). Kunxian obviously reduced CRP levels compared to placebo at weeks 2, 6, and 12 (p < 0.05). Compared with the placebo, Kunxian was associated with greater improvements in signs and symptoms of patients with AS from the baseline to week 12, and significant intergroup differences of additional composite indices of disease activity (i.e., erythrocyte sedimentation rate, patient global assessment of disease activity, total back pain, level of morning stiffness, tender joints, and BASFI scores) were also observed.

Conclusion

Kunxian capsule significantly decreased the disease activity of patients with AS.

Trial registration

NCT00953979. Registered on 5 August 2009.
Appendix
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Literature
1.
go back to reference Amor B, Kahan A, Dougados M, et al. Sulfasalazine and ankylosing spondylitis. Ann Intern Med. 1984;101(6):878.CrossRefPubMed Amor B, Kahan A, Dougados M, et al. Sulfasalazine and ankylosing spondylitis. Ann Intern Med. 1984;101(6):878.CrossRefPubMed
2.
go back to reference Tu L, Rai JC, Cao S, et al. Costs and work limitation of patients with ankylosing spondylitis in China. Clin Exp Rheumatol. 2014;32(5):661–6.PubMed Tu L, Rai JC, Cao S, et al. Costs and work limitation of patients with ankylosing spondylitis in China. Clin Exp Rheumatol. 2014;32(5):661–6.PubMed
3.
go back to reference Zongyu W, Lunhui L. Chinese raw materials botanicals. China, Yunnan. Yunnan Science and Technology Press. 2002;203:333. Zongyu W, Lunhui L. Chinese raw materials botanicals. China, Yunnan. Yunnan Science and Technology Press. 2002;203:333.
4.
go back to reference Yaofeng H, Xuesong S, Shengjiu G, et al. Analysis on Similarity of Chemical Compositions of between Tripterygium wilfordii Hook.f. and Tripterygium hypoglaucum(Levl) Hutchins. J Anhui AgriSci. 2009;37(13):5961–3. Yaofeng H, Xuesong S, Shengjiu G, et al. Analysis on Similarity of Chemical Compositions of between Tripterygium wilfordii Hook.f. and Tripterygium hypoglaucum(Levl) Hutchins. J Anhui AgriSci. 2009;37(13):5961–3.
5.
go back to reference Ji W, Li J, Lin Y, et al. Report of 12 cases of ankylosing spondylitis patients treated with Tripterygium wilfordii. Clin Rheumatol. 2010;29(9):1067–72.CrossRefPubMedPubMedCentral Ji W, Li J, Lin Y, et al. Report of 12 cases of ankylosing spondylitis patients treated with Tripterygium wilfordii. Clin Rheumatol. 2010;29(9):1067–72.CrossRefPubMedPubMedCentral
6.
go back to reference Zeng R, Shixin D, Wu J, et al. Effects of Tripterygium hypoglaucum (Levl.) Hutch on in vitro proliferation and apoptosis of synoviocytes from patients with rheumatoid arthritis. J Clin Rehabil Tissue Eng Res. 2009;13(50):9892–6. Zeng R, Shixin D, Wu J, et al. Effects of Tripterygium hypoglaucum (Levl.) Hutch on in vitro proliferation and apoptosis of synoviocytes from patients with rheumatoid arthritis. J Clin Rehabil Tissue Eng Res. 2009;13(50):9892–6.
7.
go back to reference Fan Y, Li G. Clinical study of Tripterygium hypoglaucum combined with methotrexate in elderly onset rheumatoid arthritis. Mod Med Health. 2006;22(4):478–80. Fan Y, Li G. Clinical study of Tripterygium hypoglaucum combined with methotrexate in elderly onset rheumatoid arthritis. Mod Med Health. 2006;22(4):478–80.
8.
go back to reference Xiulan D, Ma Y. Anti lupus powder treat the systemic lupus erythematosus. J Shandong University of Tradit Chin Med. 2000;24(5):354–6. Xiulan D, Ma Y. Anti lupus powder treat the systemic lupus erythematosus. J Shandong University of Tradit Chin Med. 2000;24(5):354–6.
9.
go back to reference Zhao XZ. Effects of Astragalus membranaceus and Tripterygium hypoglancum on natural killer cell activity of peripheral blood mononuclear in systemic lupus erythematosus. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1992;12(11):669–71,645.PubMed Zhao XZ. Effects of Astragalus membranaceus and Tripterygium hypoglancum on natural killer cell activity of peripheral blood mononuclear in systemic lupus erythematosus. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1992;12(11):669–71,645.PubMed
10.
go back to reference Jin CY, Hu GH, Zheng BZ, et al. Study on effect of tripterygium on plasma IL-18 content in patients with lupus nephritis. Zhongguo Zhong Yao Za Zhi. 2008;33(9):1075–7.PubMed Jin CY, Hu GH, Zheng BZ, et al. Study on effect of tripterygium on plasma IL-18 content in patients with lupus nephritis. Zhongguo Zhong Yao Za Zhi. 2008;33(9):1075–7.PubMed
11.
go back to reference Wang S, Yan C. The experience of Tripterygium piece with Liu Wei Di Huang Wan combination treat the lupus nephritis. Med J Liaoning. 2004;18(3):167–7. Wang S, Yan C. The experience of Tripterygium piece with Liu Wei Di Huang Wan combination treat the lupus nephritis. Med J Liaoning. 2004;18(3):167–7.
12.
go back to reference Wang B, Zhang X. The analysis of Tripterygium treat 56 primary glomerular disease patients. Yunnan Pharm. 1993;14(5):279–81. Wang B, Zhang X. The analysis of Tripterygium treat 56 primary glomerular disease patients. Yunnan Pharm. 1993;14(5):279–81.
13.
go back to reference Chen MF, Zhang QY, Yao J, et al. Treatment of chronic nephritis with tripterygium hypoglaucum. A clinical and experimental study. J Tradit Chin Med. 1983;3(3):219–22.PubMed Chen MF, Zhang QY, Yao J, et al. Treatment of chronic nephritis with tripterygium hypoglaucum. A clinical and experimental study. J Tradit Chin Med. 1983;3(3):219–22.PubMed
14.
go back to reference Lu J, Xu Y, Tang D, et al. The efficacy and safety study of Kunxian capsule combined with methotrexate in the treatment of elderly patients with rheumatoid arthritis. J Chin Med Mater. 2011;34(5):835–7. Lu J, Xu Y, Tang D, et al. The efficacy and safety study of Kunxian capsule combined with methotrexate in the treatment of elderly patients with rheumatoid arthritis. J Chin Med Mater. 2011;34(5):835–7.
15.
go back to reference Lin CS, Yang XY, Dai L, et al. Multi-center clinical study on therapeutic effect of kunxian capsule on rheumatoid arthritis. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2011;31(6):769–74.PubMed Lin CS, Yang XY, Dai L, et al. Multi-center clinical study on therapeutic effect of kunxian capsule on rheumatoid arthritis. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2011;31(6):769–74.PubMed
16.
go back to reference ZhaoRong Jiang, MingLi Gao, YanYan Liu. The clinical observation of Kun Xian Capsule treatment for active rheumatoid arthritis. Guangming J Chin Med. 2015;30(2):279–81. ZhaoRong Jiang, MingLi Gao, YanYan Liu. The clinical observation of Kun Xian Capsule treatment for active rheumatoid arthritis. Guangming J Chin Med.  2015;30(2):279–81.
17.
go back to reference Gao M, Li X, Qi Q, et al. The clinical observation of Kunxian capsule reducing urinary protein in lupus nephritis. J Chin Med Mater. 2010;33(4):651–2. Gao M, Li X, Qi Q, et al. The clinical observation of Kunxian capsule reducing urinary protein in lupus nephritis. J Chin Med Mater. 2010;33(4):651–2.
18.
go back to reference Lin C, Liu M, Xu Q, et al. The effect observation of Kunxian capsule treating ankylosing spondylitis. New Med. 2011;42(3):175–8. Lin C, Liu M, Xu Q, et al. The effect observation of Kunxian capsule treating ankylosing spondylitis. New Med. 2011;42(3):175–8.
19.
go back to reference Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21:228691. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21:228691.
20.
go back to reference Lukas C, Landewe´ R, Sieper J, et al. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68:1824.CrossRef Lukas C, Landewe´ R, Sieper J, et al. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68:1824.CrossRef
21.
go back to reference van der Heijde D, Lie E, Kvien TK, et al. The ASDAS is a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68:18118. van der Heijde D, Lie E, Kvien TK, et al. The ASDAS is a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68:18118.
23.
go back to reference Xu M, Lin Z, Deng X, et al. The Ankylosing Spondylitis Disease Activity Score is a highly discriminatory measure of disease activity and efficacy following tumour necrosis factor-α inhibitor therapies in ankylosing spondylitis and undifferentiated spondyloarthropathies in China. Rheumatology. 2011;50(8):1466–72.CrossRefPubMed Xu M, Lin Z, Deng X, et al. The Ankylosing Spondylitis Disease Activity Score is a highly discriminatory measure of disease activity and efficacy following tumour necrosis factor-α inhibitor therapies in ankylosing spondylitis and undifferentiated spondyloarthropathies in China. Rheumatology. 2011;50(8):1466–72.CrossRefPubMed
24.
go back to reference Brinker AM, Ma J, Lipsky PE, et al. Medicinal chemistry and pharmacology of genus Tripterygium (Celastraceae). Phytochemistry. 2007;68(6):732–66.CrossRefPubMed Brinker AM, Ma J, Lipsky PE, et al. Medicinal chemistry and pharmacology of genus Tripterygium (Celastraceae). Phytochemistry. 2007;68(6):732–66.CrossRefPubMed
25.
go back to reference Liu Q, Chen Shu J, Liu Feng H, et al. Effects of triptolide on expressions of NF-kb, NOS and VEGF in glomeruli of diabetes mellitus rats. J Clin Exp Med. 2014;13(23):1925–9. Liu Q, Chen Shu J, Liu Feng H, et al. Effects of triptolide on expressions of NF-kb, NOS and VEGF in glomeruli of diabetes mellitus rats. J Clin Exp Med. 2014;13(23):1925–9.
26.
go back to reference Ruilin L. Tripterygium wilfordii Hook.f. Should not be confused with Tripterygium hypoglaucum. Beijing Tradit Chin Med. 1984;1:53. Ruilin L. Tripterygium wilfordii Hook.f. Should not be confused with Tripterygium hypoglaucum. Beijing Tradit Chin Med. 1984;1:53.
27.
go back to reference Chen T, Li H, Mai W. Clinical efficacy of Kunxian Capsule combined with prednisone therapy for refractory nephrotic syndrome. Pharmacol Clin Chin Materia Medical. 2011;27(6):97–9. Chen T, Li H, Mai W. Clinical efficacy of Kunxian Capsule combined with prednisone therapy for refractory nephrotic syndrome. Pharmacol Clin Chin Materia Medical. 2011;27(6):97–9.
28.
go back to reference Chen B, Zhang X, Liu Y, et al. Fertility and embryotoxicity study of Fengshiping capsule in rats. J Chengdu University of Tradit Chin Med. 2007;30(1):35–8. Chen B, Zhang X, Liu Y, et al. Fertility and embryotoxicity study of Fengshiping capsule in rats. J Chengdu University of Tradit Chin Med. 2007;30(1):35–8.
Metadata
Title
Kunxian capsules in the treatment of patients with ankylosing spondylitis: a randomized placebo-controlled clinical trial
Authors
Qiuxia Li
Li Li
Liqi Bi
Changhong Xiao
Zhiming Lin
Shuangyan Cao
Zetao Liao
Jieruo Gu
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Trials / Issue 1/2016
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-016-1438-6

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