The effect and safety of low-dose Tripterygium wilfordii in patients with type 2 diabetic nephropathy: A meta-analysis.

Background: This review aims to assess the efficacy and safety of low-dose Tripterygium wilfordii Hook F (TWHF) in treating type 2 diabetic nephropathy (DN) and provide high-level evidence supporting its normalized application.

Methods: Seven electronic databases were queried to locate trials that qualify. Randomized controlled trials (RCTs) about low-dose TWHF long-term treatment of type 2 DN are included. After data extraction and quality evaluation of the clinical studies that met the inclusion criteria, a meta-analysis was performed using RevMan 5.4 and Stata 14.

Results: A total of 23 RCTs were included. For the patients in the trial group, the effective rate [confidence interval (CI), odd ratio] [odd ratio = 1.38, 95% CI (1.22-1.56), P < .001], albumin [standard mean difference (SMD) = 0.58, 95% CI (0.18-0.98), P = .004], 24-hour urine total protein [SMD = -1.329, 95% CI = (-1.647 to -1.012), P < .001], serum creatinine [SMD = -0.64, 95% CI = (-0.86 to -0.31), P < .001], and the untoward effect [RR = 2.43 95% CI = (1.23-4.82), P = .01] were significantly higher than those in the control group. However, in white blood cell [Weighted mean difference = -0.27, 95% CI (-0.54 to 0.01), P = .06] and blood urea nitrogen [Weighted mean difference = -0.11, 95% CI (-0.42 to 0.21), z = 0.67, P = .50], none of the differences were significant compared with the control group.

Conclusion: This suggests that low-dose TWHF positively affects patients with type 2 DN after a long course of treatment. Although there are some side effects, symptoms can improve after medication suspension or symptomatic treatment. Limited by the methodological quality of the included studies, this conclusion needs to be verified by more large-sample RCTs with rigorous design and long-term follow-up.