Skip to main content
Top
Published in: BMC Complementary Medicine and Therapies 1/2018

Open Access 01-12-2018 | Research article

Efficacy and safety of Tripterygium wilfordii hook F for chronic urticaria: a systematic review and meta-analysis

Authors: Liu Liu, Huaibo Zhao, Xiaoying Sun, Qi Zheng, Ying Luo, Yi Ru, Ying Zhang, Xi Chen, Bo Zhu, Chengqian Yin, Bin Li, Xin Li

Published in: BMC Complementary Medicine and Therapies | Issue 1/2018

Login to get access

Abstract

Background

The first-line agents comprising antihistamines for chronic urticaria, are not completely satisfactory. Tripterygium wilfordii Hook F (TwHF), a Chinese herb, has been developed into several Tripterygium agents and have definite effects on autoimmune and inflammatory diseases. In chronic urticaria, however, their values of practical application remain unclear. The aim of this study was to investigate the efficacy and safety of TwHF in patients with chronic urticaria.

Methods

Several databases were systematically searched including PubMed, Embase, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure, Chinese Scientific Journals Database, Wan Fang Database, and Chinese Biomedicine. Randomized controlled trials comparing antihistamines with TwHF or Tripterygium agents in combination with antihistamines were included. Revman5.3 was utilized to calculate risk ratios (RR) with 95% confidence intervals (CI). This study was registered with PROSPERO, number CRD42018091595.

Results

Twenty-one trials with 2565 participants were included in this analysis. Meta-analysis showed that, when antihistamines were combined with TwHF and Tripterygium agents, the curative effect in cases of chronic urticaria was superior to that of antihistamines alone (RR: 1.40; 95% CI: 1.33–1.46). The incidence rates of gastrointestinal disorder (RR: 2.91; 95% CI: 1.70–4.99) and menstrual disorder (RR: 6.00; 95% CI: 1.79–20.13) in drug combination groups were higher than those in controls, while other adverse events were similar between the two groups. After treatment, Dermatology Life Quality Index (RR: 1.23; 95% CI: 1.09–1.40), quality of sleep (RR: 1.50; 95% CI: 1.07–2.12), and daily activity (RR: 1.49; 95% CI: 1.25–1.78) were all improved. Furthermore, drug combination groups demonstrated less relapse (RR: 0.34; 95% CI: 0.25–0.45).

Conclusions

TwHF and Tripterygium agents, in combination with antihistamines, appear to be more effective than antihistamines alone. Nevertheless, adverse events cannot be ignored. Large sample, multi-center, high-quality clinical studies are needed to verify the exact effects and safety of TwHF and Tripterygium agents in treatment of chronic urticaria.
Appendix
Available only for authorised users
Literature
1.
go back to reference Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69:868–87.CrossRefPubMed Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69:868–87.CrossRefPubMed
2.
go back to reference Powell RJ, Du Toit GL, Siddique N, Leech SC, Dixon TA, Clark AT, et al. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy. 2007;37:631–50.CrossRefPubMed Powell RJ, Du Toit GL, Siddique N, Leech SC, Dixon TA, Clark AT, et al. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy. 2007;37:631–50.CrossRefPubMed
3.
4.
go back to reference Law SK, Simmons MP, Techen N, Khan IA, He MF, Shaw PC, et al. Molecular analyses of the Chinese herb Leigongteng (Tripterygium wilfordii Hook.F.). Phytochemistry. 2011;72(1):21–6.CrossRefPubMed Law SK, Simmons MP, Techen N, Khan IA, He MF, Shaw PC, et al. Molecular analyses of the Chinese herb Leigongteng (Tripterygium wilfordii Hook.F.). Phytochemistry. 2011;72(1):21–6.CrossRefPubMed
6.
go back to reference Liao ZH, Zhou ZH, Dai GD. Clinical effect of methotrexate and Leigong Teng duo Dai Pian on treatment of rheumatoid arthritis. Chin J Biochem Pharm. 2016;36:136–8. Liao ZH, Zhou ZH, Dai GD. Clinical effect of methotrexate and Leigong Teng duo Dai Pian on treatment of rheumatoid arthritis. Chin J Biochem Pharm. 2016;36:136–8.
7.
go back to reference Wu WH, Wang H, Zhang MP, Huang SM. Effects of Tripterygium on diabetic nephropathy: a systematic review. Chin J Evid-based Med. 2010;10:693–9. Wu WH, Wang H, Zhang MP, Huang SM. Effects of Tripterygium on diabetic nephropathy: a systematic review. Chin J Evid-based Med. 2010;10:693–9.
8.
go back to reference Liu W, Yan L, Zhu Q, Shao FM. Therapeutic effect of Tripterygium glycosides plus prednisone on moderate active systemic lupus erythematosus. J Chin Pract Diagn Ther. 2014;28:1234–8. Liu W, Yan L, Zhu Q, Shao FM. Therapeutic effect of Tripterygium glycosides plus prednisone on moderate active systemic lupus erythematosus. J Chin Pract Diagn Ther. 2014;28:1234–8.
9.
go back to reference Qian M, Zhang SY. Clinical efficacy of Triptergium Wilfordii combined with antihistamines on treating chronic Urticaria. Chin J Dermato Venerol Integ Trad W. 2011;10:359–62. Qian M, Zhang SY. Clinical efficacy of Triptergium Wilfordii combined with antihistamines on treating chronic Urticaria. Chin J Dermato Venerol Integ Trad W. 2011;10:359–62.
10.
go back to reference Meng LY, Zhang CM, Yang AB, Yu ZH. The clinical efficacy of Tripterygium hypoglaucum (levl.) hutch in combination with 5% doxepin cream on chronic urticaria. J. Clin Dermatol. 2006;35:118. Meng LY, Zhang CM, Yang AB, Yu ZH. The clinical efficacy of Tripterygium hypoglaucum (levl.) hutch in combination with 5% doxepin cream on chronic urticaria. J. Clin Dermatol. 2006;35:118.
12.
go back to reference Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;21(339):b2700.CrossRef Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;21(339):b2700.CrossRef
13.
go back to reference Pi XB, Wang XX, Mai YM, Li JH. 40 cases of mizolastine combined with tripterygium glycosides in the treatment of chronic idiopathic urticaria. Southern China Journal of Dermato-Venereol. 2006;13:130–2. Pi XB, Wang XX, Mai YM, Li JH. 40 cases of mizolastine combined with tripterygium glycosides in the treatment of chronic idiopathic urticaria. Southern China Journal of Dermato-Venereol. 2006;13:130–2.
14.
go back to reference Zhang L, Xiong B, Zhang QY. Observation on efficacy of levocetirizine combined with Tripterygium in chronic urticaria. China J Lepr Skin Dis. 2007;23:1031–2. Zhang L, Xiong B, Zhang QY. Observation on efficacy of levocetirizine combined with Tripterygium in chronic urticaria. China J Lepr Skin Dis. 2007;23:1031–2.
15.
go back to reference Bao LX. Observation on efficacy of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic urticaria. China J Lepr Skin Dis. 2008;24:568–9. Bao LX. Observation on efficacy of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic urticaria. China J Lepr Skin Dis. 2008;24:568–9.
16.
go back to reference Xu YM. Observation on efficacy of desloratadine combined with tripterygium glycosides in chronic urticaria. Chin J Dermato Venerol Integ Trad W Med. 2009;8:171–2. Xu YM. Observation on efficacy of desloratadine combined with tripterygium glycosides in chronic urticaria. Chin J Dermato Venerol Integ Trad W Med. 2009;8:171–2.
17.
go back to reference Wei YH, Zhang JH, An RZ, Wang J-l. Combination effect of Tripterygium Wilfordii with Desloratadine on theTreatment of chronic idiopathic Urticaria. Chin J Derm Venereol. 2010;24:1170–2. Wei YH, Zhang JH, An RZ, Wang J-l. Combination effect of Tripterygium Wilfordii with Desloratadine on theTreatment of chronic idiopathic Urticaria. Chin J Derm Venereol. 2010;24:1170–2.
18.
go back to reference Zhong JQ, Xian DH, Xu Y, Liu J. Efficacy of Tripterygium hypoglaucum hutch in adults with chronic Urticaria. J Altern Complement Med. 2011;17:459–64.CrossRefPubMed Zhong JQ, Xian DH, Xu Y, Liu J. Efficacy of Tripterygium hypoglaucum hutch in adults with chronic Urticaria. J Altern Complement Med. 2011;17:459–64.CrossRefPubMed
19.
go back to reference Liu J. Observation on efficacy of levocetirizine hydrochloride combined with Glucosidorum Tripterygll Totorum in chronic urticaria. Chin J Misdiagnostics. 2011;11:4356. Liu J. Observation on efficacy of levocetirizine hydrochloride combined with Glucosidorum Tripterygll Totorum in chronic urticaria. Chin J Misdiagnostics. 2011;11:4356.
20.
go back to reference Yu JM, Liang GX, Wang JX, Liao J. The clinical efficacy of tripterygium hypoglaucum hutch tablet combined with terfenadine tablet in patients with chronic urticaria. China Prac Med. 2011;6:20–1.CrossRef Yu JM, Liang GX, Wang JX, Liao J. The clinical efficacy of tripterygium hypoglaucum hutch tablet combined with terfenadine tablet in patients with chronic urticaria. China Prac Med. 2011;6:20–1.CrossRef
21.
go back to reference Lu Q. 40 cases of fexofenadine hydrochloride combined with tripterygium glycosides in the treatment of chronic urticaria. Traditional medicine. 2012;21:97–8. Lu Q. 40 cases of fexofenadine hydrochloride combined with tripterygium glycosides in the treatment of chronic urticaria. Traditional medicine. 2012;21:97–8.
22.
go back to reference Zhou JW. The clinical investigation and safety analysis of patients with chronic Urticaria in the treatment of Tripterygii Hypoglauci and mizolastine. J North Pharm. 2012;9:10–1. Zhou JW. The clinical investigation and safety analysis of patients with chronic Urticaria in the treatment of Tripterygii Hypoglauci and mizolastine. J North Pharm. 2012;9:10–1.
23.
go back to reference Fan FR. Clinical Observation on Therapeutic Effects of Chronic Urticaria Treated by Ebastine and Tripterygium wilfordii Hook.F. J Med Theor & Prac. 2013;26:993–4. Fan FR. Clinical Observation on Therapeutic Effects of Chronic Urticaria Treated by Ebastine and Tripterygium wilfordii Hook.F. J Med Theor & Prac. 2013;26:993–4.
24.
go back to reference Liu JY, Chen C. Observation on curative effect of cetirizine combined with tripterygium glycosides on chronic urticaria. J Prac Med Techniq. 2013;20:658–9. Liu JY, Chen C. Observation on curative effect of cetirizine combined with tripterygium glycosides on chronic urticaria. J Prac Med Techniq. 2013;20:658–9.
25.
go back to reference Zheng WZ, Pu R, Chen ZC, Shi JM. Observation on curative effect of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic idiopathic urticaria. Contemp Med. 2013;19:74–5. Zheng WZ, Pu R, Chen ZC, Shi JM. Observation on curative effect of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic idiopathic urticaria. Contemp Med. 2013;19:74–5.
26.
go back to reference Chen HJ. Effect observation of fexofenadine combined with Tripterygium glycosides in treating chronic urticaria. Chongqing Med. 2014;43:3302–4. Chen HJ. Effect observation of fexofenadine combined with Tripterygium glycosides in treating chronic urticaria. Chongqing Med. 2014;43:3302–4.
27.
go back to reference Wang Q. Observation on desloratadine combined with Glucosidorum Tripterygll Totorum in chronic idiopathic urticaria. Chin J Modern Drug Appl. 2014;8:98–9. Wang Q. Observation on desloratadine combined with Glucosidorum Tripterygll Totorum in chronic idiopathic urticaria. Chin J Modern Drug Appl. 2014;8:98–9.
28.
go back to reference Zhou ZD. Clinical curative effect of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic idiopathic urticaria. Med Inf. 2014;27:304–5. Zhou ZD. Clinical curative effect of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic idiopathic urticaria. Med Inf. 2014;27:304–5.
29.
go back to reference Li WH. Curative effect of ebastine combined with tripterygium glycosides in the treatment of chronic urticaria. Shenzhen J Integrated Traditional Chin and Western Med. 2016;26:88–90. Li WH. Curative effect of ebastine combined with tripterygium glycosides in the treatment of chronic urticaria. Shenzhen J Integrated Traditional Chin and Western Med. 2016;26:88–90.
30.
go back to reference Liu Z. Clinical curative effect of desloratadine combined with tripterygium glycosides on chronic idiopathic urticaria. Clini Med. 2016;36:21–2. Liu Z. Clinical curative effect of desloratadine combined with tripterygium glycosides on chronic idiopathic urticaria. Clini Med. 2016;36:21–2.
31.
go back to reference Chen T. Curative effect of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic idiopathic urticaria. Chinese And Foreign Med Res. 2017;15:24–6. Chen T. Curative effect of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic idiopathic urticaria. Chinese And Foreign Med Res. 2017;15:24–6.
32.
go back to reference Tao YF. Clinical curative effect of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic urticaria. Modern Prac Med. 2017;29:1345–6. Tao YF. Clinical curative effect of desloratadine combined with Glucosidorum Tripterygll Totorum in chronic urticaria. Modern Prac Med. 2017;29:1345–6.
33.
go back to reference Wen WT, Huang JJ, Wang PL, Yu S. System evaluation of Glucoside Tripterygium Total combined with antihistamine medicine for chronic idiopathic Urticaria. Chin J Inform on TCM. 2016;23:46–50. Wen WT, Huang JJ, Wang PL, Yu S. System evaluation of Glucoside Tripterygium Total combined with antihistamine medicine for chronic idiopathic Urticaria. Chin J Inform on TCM. 2016;23:46–50.
34.
go back to reference Li XJY, Jiang ZZ, Zhang LY. Triptolide: progress on research in pharmacodynamics and toxicology. J Ethnopharmacol. 2014;155:67–79.CrossRefPubMed Li XJY, Jiang ZZ, Zhang LY. Triptolide: progress on research in pharmacodynamics and toxicology. J Ethnopharmacol. 2014;155:67–79.CrossRefPubMed
35.
go back to reference Liu RL, Liu ZL, Li Q, Qiu ZM, Lv HJ, Yang ZM, Hong GZ. The experimental study on the inhibitory effect of tripterine on airway inflammation in asthmatic mice. Chin J Tuberc Respir Dis. 2004;27:165–8. Liu RL, Liu ZL, Li Q, Qiu ZM, Lv HJ, Yang ZM, Hong GZ. The experimental study on the inhibitory effect of tripterine on airway inflammation in asthmatic mice. Chin J Tuberc Respir Dis. 2004;27:165–8.
36.
go back to reference Yao CY, Wang T, Jiang YL, Zheng X, Lin PH. Effect of celastrol on degranulation of mast cell and possible mechanism of PI3K/AKT/GSK3-β pathway. Fujian Med J. 2017;39:61–4. Yao CY, Wang T, Jiang YL, Zheng X, Lin PH. Effect of celastrol on degranulation of mast cell and possible mechanism of PI3K/AKT/GSK3-β pathway. Fujian Med J. 2017;39:61–4.
37.
go back to reference Li YL, Qi XY. Literature investigation and analysis of adverse events in 294 cases of Tripterygium. Shanxi Med J. 2011;40:88–90. Li YL, Qi XY. Literature investigation and analysis of adverse events in 294 cases of Tripterygium. Shanxi Med J. 2011;40:88–90.
38.
go back to reference Yang W, Huang YK, Lei LX, Xiao BQ, Sun H. Study on toxicity of Tripterygium glycosides to digestive tract. The seventh National Toxicology Conference of the Chinese Society of Toxicology and the eighth Hubei science and technology forum; 2015; Wuhan, Hubei. China. Yang W, Huang YK, Lei LX, Xiao BQ, Sun H. Study on toxicity of Tripterygium glycosides to digestive tract. The seventh National Toxicology Conference of the Chinese Society of Toxicology and the eighth Hubei science and technology forum; 2015; Wuhan, Hubei. China.
39.
go back to reference Fan XZ, Chen Y, Li XD. Investigation of adverse reactions caused by Tripterygium wifordii Hook.f in patients with immune diseases. Chin J Integrated Traditional and Western Nephrology. 2001;02:83–5. Fan XZ, Chen Y, Li XD. Investigation of adverse reactions caused by Tripterygium wifordii Hook.f in patients with immune diseases. Chin J Integrated Traditional and Western Nephrology. 2001;02:83–5.
40.
go back to reference Zhou LZ, Gu JH. Research progress on toxic side effects and detoxification methods of Tripterygium wilfordii to female reproductive system. Gansu J TCM. 2011;24:75–7. Zhou LZ, Gu JH. Research progress on toxic side effects and detoxification methods of Tripterygium wilfordii to female reproductive system. Gansu J TCM. 2011;24:75–7.
41.
go back to reference Xi YB, Xia BY, Zheng DM. Research status of reproductive toxicity of Tripterygium wilfordii Hook.F. Nei Mongol J Tradit Chin Med. 2011;30:126–8. Xi YB, Xia BY, Zheng DM. Research status of reproductive toxicity of Tripterygium wilfordii Hook.F. Nei Mongol J Tradit Chin Med. 2011;30:126–8.
42.
go back to reference Cao LJ, Yan M, Li HD, Zhang KB, Fang PF. Progress on mechanism of Tripterygium wilfordii-induced liver injury and detoxification mechanism of licorice. China Journal of Chinese Materia Medica. 2015;40:2537–41.PubMed Cao LJ, Yan M, Li HD, Zhang KB, Fang PF. Progress on mechanism of Tripterygium wilfordii-induced liver injury and detoxification mechanism of licorice. China Journal of Chinese Materia Medica. 2015;40:2537–41.PubMed
43.
go back to reference Li WY. Adverse reactions and prevention measures of Tripterygium wilfordii and its preparation. Capital Medicine. 2012;19:47–9. Li WY. Adverse reactions and prevention measures of Tripterygium wilfordii and its preparation. Capital Medicine. 2012;19:47–9.
44.
go back to reference Li HG, Ji W, Su JM, Song YN, Ma CG. Literature research of the hepatotoxicity of Glucoside Tripterygium Total and its synergism and toxicity reducing effects. Chin J Integr Trad West Med. 2012;32:415–8.CrossRef Li HG, Ji W, Su JM, Song YN, Ma CG. Literature research of the hepatotoxicity of Glucoside Tripterygium Total and its synergism and toxicity reducing effects. Chin J Integr Trad West Med. 2012;32:415–8.CrossRef
Metadata
Title
Efficacy and safety of Tripterygium wilfordii hook F for chronic urticaria: a systematic review and meta-analysis
Authors
Liu Liu
Huaibo Zhao
Xiaoying Sun
Qi Zheng
Ying Luo
Yi Ru
Ying Zhang
Xi Chen
Bo Zhu
Chengqian Yin
Bin Li
Xin Li
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2018
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-018-2305-7

Other articles of this Issue 1/2018

BMC Complementary Medicine and Therapies 1/2018 Go to the issue