Tripterygium wilfordii Hook F (TwHF) is a Chinese herbal medicine with immunosuppressive effects and an established history of use in the treatment of inflammatory and autoimmune diseases. We have carried out a meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs which assessed the effectiveness of TwHF in the treatment for idiopathic refractory nephrotic syndrome (IRNS). After reading the full text, only three RCTs or quasi-RCTs meeting our inclusion criteria were selected. Our meta-analysis indicated that TwHF has beneficial effects on the remission of IRNS. There was no significant publication bias in the meta-analysis studies. However, studies with a larger sample size and including patients with both a mild and severe histopathological change involvement separately are needed to assess the effects of TwHF in IRNS patients before exact conclusions can be drawn.

Keywords:
Nephrotic syndrome, Refractory nephrotic syndrome, Idiopathic refractory nephrotic syndrome, meta-analysis, Immunosuppressive agents, Tripterygium wilfordii Hook F
1.
Chang DM, Chang WY, Kuo SY, Chang ML: The effects of traditional antirheumatic herbal medicines on immune response cells. J Rheumatol 1997;24:436–441.
2.
Wong KF, Chan JK, Chan KL, Tam P, Yang D, Fan ST, Luk JM: Immunochemical characterization of the functional constituents of Tripterygium wilfordii contributing to its anti-inflammatory property. Clin Exp Pharmacol Physiol 2008;35:55–59.
3.
Ji SM, Wang QW, Chen JS, Sha GZ, Liu ZH, Li LS: Clinical trial of Tripterygium wilfordii Hook F in human kidney transplantation in China. Transplant Proc 2006;38:1274–1279.
4.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1–12.
5.
He JY: Combined leflunomide and Tripterygium wilfordii with prednisone to treat idiopathic refractory nephrotic syndrome. Chin J Nephrol 2007;23:206.
6.
Zhong ZH, Lu JJ, Cai CD: Clinical analysis of Prednisone and Tripterygium wilfordii treatment for relapsing nephrotic syndrome. Clin Med Chin 2002;18:435–436.
7.
Xiao HQ, Ding GH, Zhang JE, Zhang QH, Li T, Luo CX: Comparison between Tripterygium wilfordii and cyclophosphamide treatment for idiopathic refractory nephrotic syndrome. Clin Focus 2003;18:1039–1040.
8.
Patavino T, Brady DM: Natural medicine and nutritional therapy as an alternative treatment in systemic lupus erythematosus. Altern Med Rev 2001;6:460–471.
9.
Ioannidis JP: Genetic associations: false or true? Trends Mol Med 2003;9:135–138.
10.
Lee YH, Harley JB, Nath SK: CTLA-4 polymorphisms and systemic lupus erythematosus: a meta-analysis. Hum Genet 2005;116:361–367.
11.
Wang XD, Gao WY, Yao Z, Zhang SY, Zhang YW, Takaishi Y, Duan HQ: Immunosuppressive sesquiterpenes from Tripterygium wilfordii. Chem Pharm Bull 2005;53:607–610.
12.
Tao X, Sun Y, Dong Y, et al: A prospective, controlled, double-blind, crossover study of Tripterygium Wilfordii Hook F in the treatment of rheumatoid arthritis. Chin Med J Engl 1989;102:327–331.
13.
Gu WZ, Brandwein SR: Inhibition of type II collagen induced arthritis in rats by triptolide. Int J Immunopharmacol 1998;20:389–400.
14.
Zheng J, Gu K, Xu L, Gao J, Yu Y, Tang M: Screening of active anti-inflammatory, immunosuppressive and antifertility components of Tripterygium wilfordii. III. A comparison of the anti-inflammatory and immunosuppressive activities of 7 diterpene lactone epoxide compounds in vivo. Acta Acad Med Sin 1991;13:391–397.
15.
Zheng J, Feng K, Gu K: Screening of active anti-inflammatory, immunosuppressive and antifertility components of Tripterygium wilfordii V. Effects of 7 diterpene lactone epoxide compounds on the proliferation of T and B lymphocytes in vitro. Acta Acad Med Sin 1994;16:24–28.
16.
Wang B, Ma L, Tao X, Lipsky PE: Triptolide, an active component of the Chinese herbal remedy Tripterygium wilfordii Hook F, inhibits production of nitric oxide by decreasing inducible nitric oxide synthase. Arthritis Rheum 2004;50:2995–3003.
17.
Hong Y, Zhou W, Li K, Sacks SH: Triptolide is a potent suppressant of C3, CD40 and B7h expression in activated human proximal tubular epithelial cells. Kidney Int 2002;62:1291–1300.
18.
Krishna G, Liu K, Shigemitsu H: PG-490-88, a derivative of triptolide, blocks bleomycin-induced lung fibrosis. Am J Pathol 2001;158:997–1004.
19.
Tao X, Cush JJ, Garret M, Lipsky PE: A phase I study of ethyl acetate extract of the Chinese antirheumatic herb Tripterygium wilfordii Hook F in rheumatoid arthritis. J Rheumatol 2001;28:2160–2167.
20.
Tao X, Lipsky PE: The Chinese anti-inflammatory and immunosuppressive herbal remedy Tripterygium wilfordii Hook F. Rheum Dis Clin North Am 2000;26:29–50.
21.
Chen JR, Yen JH, Lin CC, et al: The effects of Chinese herbs on improving survival and inhibiting anti-dsDNA antibody production in lupus mice. Am J Chin Med 1993;21:257–262.
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2009
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