Network Meta-analysis of Integrated Traditional Chinese and Western Medicine in the Treatment of Sjogren's Syndrome

Overview

Journal Front Pharmacol

Date 2024 Dec 12

PMID 39664524

Authors

Xieli Ma

Zixia Liu

Tian Chang

Chuanhui Yao

Yuchen Yang

Biyue Shang

Jiameng Liu

Congmin Xia

Xun Gong

Quan Jiang

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate efficacy and safety of traditional Chinese medicine (TCM) combined with Western medicine in treatment of Sjogren's syndrome (SS).

Methods: CNKI, WanFang, VIP, CBM, Sinomed, PubMed, Embase, and Web of Science were searched to collect randomized controlled trials (RCTs) of TCM combined with conventional western medicine (CWM) in treating SS from the time of their estalishment to May 2023. The researchers independently screened the literature and extracted data for quality evaluation. Analyses were performed using Review Manager (version 5.4) and R-4.3.1.

Results: A total of 66 RCTs were included, with a sample size of 5,052, involving four kinds of TCM (total glucosides of paeony capsules, tripterygium glycosides tablet, Xinfeng capsule and Jinju Qingrun capsule) and three kinds of CWM(hydroxychloroquine sulfate, Iguratimod and glucocorticoid). The network meta-analysis results showed that IGU + HCQ + TGP ranked the highest in reducing ESR and IgG and improving the Schirmer test when the three drugs were combined. When the two drugs are combined, IGU + GC and TGT + TGP are good choices for reducing erythrocyte sedimentation rate (ESR) and Immunoglobulin G (IgG). Although TGP + HCQ vs. HCQ had the most studies, TGP combined with HCQ did not rank high in each outcome indicator. It is recommended to use TGT and XFG in decreasing ESR and IgG for a single drug. JJQR have an advantageous role in relieving xerostomia and dry eyes.

Conclusion: TCM combined with CWM has a very significant effect on treating SS compared with CWM alone. According to the network meta-analysis, the best intervention measures of different TCMs for different outcome indicators were obtained.

Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42023451845].

References

Zhu F, Liu J, Fang L, Zhang P, Tan B . [Efficay Observation of Xinfeng Capsule for Treating 58 Cases of Sjogren's Syndrome]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2019; 36(11):1323-1328. View

Ramos-Casals M, Brito-Zeron P, Siso-Almirall A, Bosch X . Primary Sjogren syndrome. BMJ. 2012; 344:e3821. DOI: 10.1136/bmj.e3821. View

Higgins J, Welton N . Network meta-analysis: a norm for comparative effectiveness?. Lancet. 2015; 386(9994):628-30. DOI: 10.1016/S0140-6736(15)61478-7. View

Vitali C, Bombardieri S, Jonsson R, Moutsopoulos H, Alexander E, Carsons S . Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002; 61(6):554-8. PMC: 1754137. DOI: 10.1136/ard.61.6.554. View

Seror R, Nocturne G, Mariette X . Current and future therapies for primary Sjögren syndrome. Nat Rev Rheumatol. 2021; 17(8):475-486. DOI: 10.1038/s41584-021-00634-x. View

Wang Z, Xu Y, Liang S . Network pharmacology and molecular docking analysis on the mechanism of Tripterygium wilfordii Hook in the treatment of Sjögren syndrome. Medicine (Baltimore). 2024; 103(14):e37532. PMC: 10994482. DOI: 10.1097/MD.0000000000037532. View

Li B, Liu G, Liu R, He S, Li X, Huang L . Total glucosides of paeony (TGP) alleviates Sjogren's syndrome through inhibiting inflammatory responses in mice. Phytomedicine. 2020; 71:153203. DOI: 10.1016/j.phymed.2020.153203. View

Shiboski C, Shiboski S, Seror R, Criswell L, Labetoulle M, Lietman T . 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2016; 76(1):9-16. DOI: 10.1136/annrheumdis-2016-210571. View

Mariette X, Criswell L . Primary Sjögren's Syndrome. N Engl J Med. 2018; 378(10):931-939. DOI: 10.1056/NEJMcp1702514. View

10.

Beydon M, McCoy S, Nguyen Y, Sumida T, Mariette X, Seror R . Epidemiology of Sjögren syndrome. Nat Rev Rheumatol. 2023; 20(3):158-169. DOI: 10.1038/s41584-023-01057-6. View

11.

Brito-Zeron P, Baldini C, Bootsma H, Bowman S, Jonsson R, Mariette X . Sjögren syndrome. Nat Rev Dis Primers. 2016; 2:16047. DOI: 10.1038/nrdp.2016.47. View

12.

Zhang W, Xia S, Ou J, Cao M, Cheng G, Li Z . A single-cell landscape of triptolide-associated testicular toxicity in mice. J Pharm Anal. 2023; 13(8):880-893. PMC: 10499588. DOI: 10.1016/j.jpha.2023.04.006. View

13.

Baldini C, Fulvio G, La Rocca G, Ferro F . Update on the pathophysiology and treatment of primary Sjögren syndrome. Nat Rev Rheumatol. 2024; 20(8):473-491. DOI: 10.1038/s41584-024-01135-3. View