Traditional Chinese medicine in synergy with conventional therapy improves renal outcomes and provides survival benefit in patients with systemic lupus erythematosus: a cohort study from the largest health care system in Taiwan

Abstract

Background: Systemic lupus erythematosus (SLE) is a multifaceted autoimmune disorder that significantly impacts renal function. Despite conventional treatments, morbidity and mortality remain high, necessitating the exploration of safer and more effective therapies, including the potential benefits of Traditional Chinese Medicine (TCM) for improving kidney health and survival rates.

Methods: Patients with newly diagnosed SLE with catastrophic illness certificate were retrospectively enrolled from the Chang Gung Research Database (CGRD) between 2005 and 2020. Patients were stratified into groups based on TCM treatment post-diagnosis. Outcomes measured included end-stage renal disease (ESRD) incidence and all-cause mortality, using Cox proportional hazard models and Kaplan-Meier analysis for statistical evaluation.

Results: Among 10,462 newly diagnosed SLE patients, 1,831 had received at least 28 days of TCM treatment, while 7,966 had not received TCM treatment. After propensity score matching, there were equally 1,831 individuals in each group, with no significant baseline differences in age, sex, biochemical profiles, or comorbidities. TCM usage was associated with a significantly reduced rate of ESRD over a 0.5-year follow-up (adjusted hazard ratio (aHR) = 0.24; 95% confidence interval (CI) = 0.07-0.80, p = .02), with a trend that persisted over 5 years. The TCM group's proteinuria was significantly lower than that of the non-TCM group at various time points post-index date, including 6 months (174.98 mg vs. 248.09 mg, p <.001), 1 year (161.05 mg vs. 303.03 mg, p <.001), 3 years (150.26 mg vs. 250 mg, p = .03), and 10 years (147.06 mg vs. 190.75 mg, p = .03). After adjusting for confounding covariates, TCM users had a significantly decreased risk of mortality (aHR = 0.70, 95% CI = 0.58-0.83).

Conclusion: Integrating TCM with conventional treatment could lower risk of ESRD and mortality, highlighting the potential for a more holistic approach to patient care for SLE.

Keywords: End-stage renal disease; lupus nephritis; mortality; proteinuria; systemic lupus erythematosus; traditional Chinese medicine.