Total Glucosides of Paeony Reduces Leukopenia, Hepatic Adverse Effect From Some RA Drugs

In this systematic review and meta-analysis, investigators aimed to evaluate the clinical safety of total glucosides of paeony (TGP) adjuvant therapy in the treatment of rheumatoid arthritis (RA).

In patients with rheumatoid arthritis (RA), total glucosides of paeony (TGP) adjunct therapy might reduce the incidence of hepatic adverse effect and leukopenia associated with conventional RA treatment, such as methotrexate and leflunomide, according to a study published in BMC Complementary Medicine and Therapies.1

TGP, an active compound extracted from the roots of Paeonia lactiflora Pallas, has been increasingly used as the adjunctive therapy for patients with RA. TGP has been shown to have both anti-inflammatory and immunosuppressive effects and to be hepatoprotective. The addition of TGP to methotrexate and leflunomide therapy in patients with RA has been shown to further reduce erythrocyte sedimentation rate, C-reactive protein level and rheumatoid factor, as well as hepatotoxicity.

“Hepatic adverse effect is 1 of the main adverse effects of methotrexate and leflunomide in the treatment of RA,” stated investigators.“Though TGP could mitigate the unanticipated adverse effects during the conventional treatment of RA, high-quality evidence-based meta-analysis data on this subject are still insufficient.”

In this his systematic review and meta-analysis, Yanping Wang, MB, of the China Academy of Chinese Medical Sciences in Beijing, and colleagues, aimed to evaluate the clinical safety of TGP adjuvant therapy in the treatment of RA. A total of 39 studies involving 3680 RA participants were included. Along with leukopenia, gastrointestinal, cutaneous, hepatic and nervous system adverse effects were analyzed in TGP adjuvant therapy and non-TGP therapy. Investigators compared 8 treatments with and without the addition of TGP: methotrexate, leflunomide, methotrexate plus leflunomide, tripterygium glycosides, meloxicam, sulfasalazine, iguratimod, and prednisone acetate.

Results showed that the occurrence of hepatic adverse effect (RR = 0.31, 95% CI = 0.23–0.41, P < 0.00001) and leukopenia (RR = 0.41, 95% CI = 0.26–0.66, P = 0.0002) in TGP adjuvant therapy was significantly decreased compared with non-TGP therapy. However, only TGP plus leflunomide (RR = 0.22, 95% CI = 0.08–0.60, P = 0.003) and TGP plus methotrexate and leflunomide (RR = 0.31, 95% CI = 0.22–0.42, P < 0.00001) had statistical differences in the subgroups of hepatic adverse effect. In leukopenia, TGP plus methotrexate and leflunomide showed a statistical difference (RR = 0.47, 95% CI = 0.25–0.87, P = 0.02).

No statistical significance was found in a subgroup analysis of gastrointestinal, nervous system and cutaneous adverse effects, which the authors explained might be due to the small sample size and the poor quality of methodologies used in the included studies.

“Further large sample, multicenter, high-quality studies are still needed to confirm the clinical safety of TGP adjuvant therapy,” concluded investigators.


Liu B, Meng X, Ma Y, et al. Clinical safety of total glucosides of paeony adjuvant therapy for rheumatoid arthritis treatment: a systematic review and meta-analysis. BMC Complement Med Ther. 2021;21(1):102. Published 2021 Mar 26. doi:10.1186/s12906-021-03252-y

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