Table 1 Characteristics of included systematic reviews and meta-analyses
Study ID | Country | Language | Stagea | n (trials) | n (cases) | SRs/MAs | Study type | Follow-up (months) | Main conclusion |
|---|---|---|---|---|---|---|---|---|---|
Wu W. H. 2010 [12] | China | Chinese | IV/NR | 12 | 862 | Both | RCT/qRCT | 1~6 | TWP may be a kind of medicine relatively safe and effective for DN. However, the evidence is not strong enough because of some low-quality trials and publication bias. Rigorously designed, randomized, double-blind, and placebo-controlled trials of TWP for DN are needed to further assess the effect |
Xie H. Y. 2012 [25] | China | Chinese | NR | 26 | 1701b | Both | NR | NR | Due to the poor methodologic quality of the original studies, more rigorously designed, randomized, double-blind, and placebo-controlled trials of TWP on DN are needed to support the evidence |
Chen Y. 2013 [27] | China | Chinese | IV/NR | 20 | 1414 | Both | RCT/CCT | 1~12 | The treatment with TWP could reduce the proteinuria of DKD, but increased the risk of adverse events among DKD patients. The quality of evidence was not high |
Huang J. 2015 [28] | China | Chinese | IV | 13 | 1119 | Both | RCT/qRCT | 1~6 | Tripterygium glycosides combined with ACEI/ARB in treating diabetic nephropathy stage 4 are supper than the single administration of ACEI/ARB, with a good prospect in clinical application. Nevertheless, due to the small-size and low-quality samples in this study, more high-quality and large sample-size randomized controlled trials shall be conducted to verify the findings |
Luo J. J. 2016 [19] | China | Chinese | NR | 8b | 572b | Both | NR | NR | The treatment of TWP on DKD exhibited significant anti-proteinuria function, along with increased efficacy and safety, which is critically important for clinical practice |
Liang X. H. 2016 [22] | China | Chinese | NR | 10 | 584 | Both | RCT | 24~36 | TWP showed significantly clinical benefits on DKD. More basic experiments and large sample-size randomized controlled trials on this topic are needed |
Liao Z. M. 2016 [20] | China | Chinese | IV/NR | 29 | 2111 | Both | RCT/qRCT | 1~12 | Tripterygium glycosides treatment of diabetic nephropathy has a role in reducing proteinuria but accompanied by a decrease in plasma proteins, no significant effect on renal function |
Hong Y. 2016 [24] | China | English | IV | 14 | 992 | Both | CCT | 1~6 | The present evidence shows that Tripterygium glycosides can improve clinical efficacy, reduce the 24-h urinary protein and serum creatinine, but that they increase the Tripterygium glycoside-related toxicity in treatment of stage 4 diabetic nephropathy |
Dai X. Y. 2018 [29] | China | Chinese | IV | 11 | 859 | Both | RCT | NR | Combined use of Tripterygium glucosides in treating DKD stage 4 has advantages in improving clinical efficacy and decreasing ALB, but more high-quality researches are needed to make further analysis and demonstration |
Liu K. 2019 [21] | China | Chinese | NR | 16 | 1482 | Both | RCT | 0.5~12 | TWP combined with ACEI/ARB class drugs in the treatment of diabetic nephropathy is better than ACEI/ARB class drugs alone, with better clinical efficacy. However, due to the low quality of the included literature, high quality, large-sample randomized controlled trials are still needed for confirmation |
Zhu G. S. 2019 [26] | China | Chinese | NR | 14 | 826 | Both | RCT | 1~6 | The overall efficiency of TWP in the treatment of DKD is significant. It has lower UP, BUN, and Scr levels compared with RAAS blockers, while its adverse reaction incidence is comparable to that of RAAS blockers |
Ren D. J. 2019 [23] | China | English | IV | 22 | 1414 | Both | RCT | 1~12 | TWP combined with ARB/ACEI in the treatment of DKD stage 4 is superior to the monotherapy of ARB/ACEI |
Ye W. C. 2019 [30] | China | English | NR | 12 | 829 | Both | RCT | 1~6 | Combination therapy of Tripterygium glycosides plus valsartan may be effective for the treatment of DN. However, the safety of the combination therapy needs to be further confirmed |
Wang Y. 2020 [17] | China | English | IV | 18 | 1160 | Both | RCT | 1~12 | The combination treatment of TG and ARB showed promising results regarding significant proteinuria reduction and serum albumin improvement for DKD but with a higher risk of adverse events. Further higher-quality studies are necessary to provide solid evidence to determine a rational treatment strategy including TG while maximizing antiproteinuric effects and minimizing adverse events for DKD patients |
Chen H. 2020 [14] | China | Chinese | NR | 13 | 1143 | Both | RCT | 3~4 | Adding TWP to the routine treatment of DKD could effectively improve the patients’ body inflammation and delay the progression of DKD. Attention should be paid to abnormal liver function, leukopenia, and other adverse reactions in the treatment process |
Fang L. 2020 [15] | China | Chinese | NR | 22 | 1736 | Both | NR | 1~12 | TWP was weekly recommended for the treatment of DKD |
Zhang M. J. 2020 [13] | China | Chinese | NR | 16 | 973 | Both | RCT | 2~6 | The TWP has affirmative effect in the treatment of DKD with acceptable safety; this conclusion needs to be verified by more high-quality, large-sample, multicenter randomized double-blind controlled trials |
Fang J. Y. 2020 [18] | China | English | III~V | 9 | 851 | Both | RCT | 1~12 | In patients with DN, adding TGs to ACE inhibitors or ARBs significantly lowered both the 24-h UTP and SCr levels. Therefore, ACE inhibitors or ARBs plus TGs might improve the treatment of DN in patients |
Wu X. 2020 [16] | China | English | NR | 23 | 1810 | Both | RCT | 0.5~12 | TG combined with ARB offers a novel concept in treating DN; more high-quality RCTs are needed for better understanding and applying the combined treatment in DN |