Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jan 31:13:834947.
doi: 10.3389/fphar.2022.834947. eCollection 2022.

Total Glucosides of Paeonia lactiflora for Safely Reducing Disease Activity in Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis

Yifan Chen  1 , Liuding Wang  1 , Yu Cao  1 , Nannan Li  1
Affiliations
Review

Total Glucosides of Paeonia lactiflora for Safely Reducing Disease Activity in Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis

Yifan Chen et al. Front Pharmacol. .

Abstract

Background: Total glucosides of paeony (TGP), extracted from the dried roots of Paeonia lactiflora Pall., are proven to regulate immune function in various rheumatic diseases. We aim to systematically evaluate the efficacy and safety of TGP in reducing disease activity in systemic lupus erythematosus (SLE). Methods: We searched trials in seven electronic databases and two clinical trail registries. Randomized controlled trials (RCTs) evaluating efficacy and safety of TGP for SLE were identified. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment of the included trials, and RevMan 5.4 software was used for meta-analysis. Results: A total of 14 RCTs were included, including 978 participants, 492 in the intervention group and 486 in the control group. Regarding the efficacy of TGP for SLE, results showed that TGP plus conventional treatments (CTs) was superior to CTs alone in reducing disease activity (MD SLEDAI-1m = -3.54, 95% CI = -4.08 to -3.00, p < 0.00001; MD SLEDAI-2m = -3.80, 95% CI = -4.51 to -3.09, p < 0.00001; MD SLEDAI-3m = -1.62, 95% CI = -2.60 to -0.64, p < 0.0001; MD SLEDAI-6m = -1.97, 95% CI = -3.18 to -0.76, p = 0.001). The results also showed that TGP contributed to a betterment in improving other outcomes related to lupus activity, such as ESR, CRP, complement proteins (C3, C4), and immunoglobulins (IgA, IgM). In addition, TGP significantly decreased average daily glucocorticoid dosage and cumulative cyclophosamide dosage, as well as disease recurrence rate. In terms of safety, TGP may reduce the incidence of adverse reactions (RR = 0.51, 95% CI = 0.29 to 0.88, p = 0.01). The certainty of the evidence were assessed as moderate to low. Conclusion: TGP appears potentially effective and generally safe in reducing disease activity in SLE. However, in view of high risk of bias, the findings need to be confirmed in high-quality trials. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42021274850.

Keywords: disease activity; meta-analysis; safety; systemic lupus erythematosus; total glucosides of paeony.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PubChem identifier: Paeoniflorin.
FIGURE 2
FIGURE 2
Flow diagram for identification of studies.
FIGURE 3
FIGURE 3
Risk of bias of included studies.
FIGURE 4
FIGURE 4
Forest plot of SLEDAI score at 1 month, 2 months (A), 3 and 6 months (B).
FIGURE 5
FIGURE 5
Forest plot of ESR (A), CRP (B) and 24-h urine protein (C).
FIGURE 6
FIGURE 6
Forest plot of C3 and C4.
FIGURE 7
FIGURE 7
Forest plot of IgA, IgM and IgG.
FIGURE 8
FIGURE 8
Forest plot of average daily glucocorticoid dosage at 1 month, 2 and 3 months (A) and 6 months (B).
FIGURE 9
FIGURE 9
Forest plot of cumulative cyclophosamide dosage at 1 month, 2 months (A) and 6 months (B).
FIGURE 10
FIGURE 10
Forest plot of disease recurrence rate.
FIGURE 11
FIGURE 11
Forest plot of incidence of adverse reactions.
FIGURE 12
FIGURE 12
Funnel plot of incidence of adverse reactions.
FIGURE 13
FIGURE 13
Publication bias. (A) The Begg’s test on incidence of adverse reactions. (B) The Egger’s test on incidence of adverse reactions.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Apostolopoulos D., Morand E. F. (2016). It Hasn't Gone Away: the Problem of Glucocorticoid Use in Lupus Remains. Rheumatology 56 (Suppl. l_1), i114–i122. 10.1093/rheumatology/kew406 - DOI - PubMed
    1. Balshem H., Helfand M., Schünemann H. J., Oxman A. D., Kunz R., Brozek J., et al. (2011). GRADE Guidelines: 3. Rating the Quality of Evidence. J. Clin. Epidemiol. 64 (4), 401–406. 10.1016/j.jclinepi.2010.07.015 - DOI - PubMed
    1. Bombardier C., Gladman D. D., Urowitz M. B., Caron D., Chang C. H., Austin A., et al. (1992). Derivation of the SLEDAI. A Disease Activity index for Lupus Patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum. 35 (6), 630–640. 10.1002/art.1780350606 - DOI - PubMed
    1. Cai H. Y., Cai Z. H., Shao L. P. (2017). Therapeutic Effect of Total Glucosides of Paeony on Systemic Lupus Erythematosus. J. Chin. Physician 19 (03), 445–447. 10.3760/cma.j.issn.1008-1372.2017.03.036 - DOI
    1. Chen D., Li H., Xie J., Zhan Z., Liang L., Yang X. (2017). Herpes Zoster in Patients with Systemic Lupus Erythematosus: Clinical Features, Complications and Risk Factors. Exp. Ther. Med. 14 (6), 6222–6228. 10.3892/etm.2017.5297 - DOI - PMC - PubMed