For several decades, the extracts of Tripterigium wilfordii Hook F or TwHF (a traditional Chinese herbal medicine) and methotrexate (MTX) have been used for rheumatoid arthritis treatment in China. But,  the efficacy and safety of MTX and TwHF treatment is debatable.

A comprehensive search of databases in both Chinese and English was executed. Two authors independently extracted and investigated data from the selected studies.

A total of 643 patients participated in six randomized controlled trials incorporated in the final analysis. TwHF (in the form of Tripterygium glycosides) was added to the MTX-based therapy in all trials.

For efficacy, the addition of TwHF increased 50% responder rates (RR) (RR 1.337, 95% confidence interval [CI]: 1.188-1.505, P<0.001), and it lowered swollen and tender joint counts, shortened the duration of morning stiffness, decreased the erythrocyte sedimentation rate, and decreased the level of C-reactive protein and rheumatoid factor. For safety, the addition of TwHF did not augement the rate of adverse events (RR 0.824, 95% CI: 0.635-1.068, P=0.143).

Thus, we came to know that

MTX plus TwHF therapy may be a more effective and similar safe strategy for RA management as compared to MTX monotherapy. Although, further large clinical trials to investigate the TwHF add-on therapy are permitted.