Combined use of total glucosides of paeony and hydroxychloroquine in primary Sjögren's syndrome: A systematic review.

2023-10
Immunity, inflammation and disease 11(10)
- Aiping Zhang
- Shilei Chen
- Riyang Lin

PubMed: 37904705
DOI: 10.1002/iid3.1044

Study Design

Type: Meta-Analysis
Sample size: n = 632
Population: 632 participants with primary Sjögren's syndrome
Methods: Eight databases were searched for randomized controlled trials (RCTs) reporting the use of TGP combined with HCQ for pSS, which are before May 10, 2022. Meta-analyses were performed on disappeared clinical symptoms (dry mouth and dry eyes), Schirmer's test, saliva flow test, ESR, IgG, IgM, IgA, and adverse events.

Objective

To assess the effectiveness and safety of the total glucosides of paeony (TGP) combined with hydroxychloroquine (HCQ) on the treatment of primary Sjögren's syndrome (pSS) by conducting a meta-analysis.

Methods

Eight databases were searched for randomized controlled trials (RCTs) reporting the use of TGP combined with HCQ for pSS, which are before May 10, 2022. Meta-analyses were performed on disappeared clinical symptoms (dry mouth and dry eyes), Schirmer's test, saliva flow test, erythrocyte sedimentation rate (ESR), index of immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), and adverse events (AEs). The Revman 5.4 software was used for this meta-analysis.

Results

Seven RCTs which included 632 participants were identified. The pooled results showed significant differences in clinical symptoms disappear (dry mouth and dry eyes) (p = .0004), IgM (p < .00001), IgA (p < .00001), salivary flow rate (p < .00001) and Schirmer's test (p = .02) in the comparison of TGP combined with HCQ and HCQ alone. For the IgG and ESR, both pooled and subgroup analyses showed that TGP + HCQ was superior to HCQ alone. For the safety analysis, no significant differences in AEs (p = .39) was revealed. The more frequently seen adverse reactions were diarrhea, vomit and there was no severe adverse events were reported in TGP + HCQ group.

Conclusion

Therefore, TGP + HCQ can be considered to be a potentially valid and safe combination for the treatment of pSS in the clinic.

Research Insights

Peony→Improved Dry Eye Resolution
The pooled results showed significant differences in clinical symptoms disappear (dry mouth and dry eyes) (p = .0004)
Effect
Beneficial
Effect size
Moderate
Peony→Improved Dry Mouth Resolution
The pooled results showed significant differences in clinical symptoms disappear (dry mouth and dry eyes) (p = .0004)
Effect
Beneficial
Effect size
Moderate
Peony→Improved Tear Secretion
Schirmer's test (p = .02)
Effect
Beneficial
Effect size
Moderate
Peony→Increased Immunoglobulin G Levels
For the IgG and ESR, both pooled and subgroup analyses showed that TGP + HCQ was superior to HCQ alone.
Effect
Beneficial
Effect size
Moderate
Peony→Increased Salivary Flow Rate
salivary flow rate (p < .00001)
Effect
Beneficial
Effect size
Moderate
Peony→Increased Serum Immunoglobulin A (IgA) Levels
IgA (p < .00001)
Effect
Beneficial
Effect size
Moderate
Peony→Reduced Erythrocyte Sedimentation Rate
For the IgG and ESR, both pooled and subgroup analyses showed that TGP + HCQ was superior to HCQ alone.
Effect
Beneficial
Effect size
Moderate
Peony→Reduced Immunoglobulin M Level
IgM (p < .00001)
Effect
Beneficial
Effect size
Moderate

Adverse Events Reported

Peony→Overall tolerability
For the safety analysis, no significant differences in AEs (p = .39) was revealed.
Finding
No significant difference
Significant
No
Peony→diarrhea
The more frequently seen adverse reactions were diarrhea, vomit and there was no severe adverse events were reported in TGP+HCQ group.
Finding
Reported
Peony→vomit
The more frequently seen adverse reactions were diarrhea, vomit and there was no severe adverse events were reported in TGP+HCQ group.
Finding
Reported