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Integrative therapy decreases the risk of lupus nephritis in patients with systemic lupus erythematosus: A population-based retrospective cohort study

Authors Chang, Ching-Mao; Wu, Po-Chang; Chiang, Jen-Huai; Wei, Yau-Huei; Chen, Fang-Pey; Chen, Tzeng-Ji; Pan, Tai-Long; Yen, Hung-Rong; Chang, Hen-Hong

Journal JOURNAL OF ETHNOPHARMACOLOGY , JAN 20 2017,:196

DOI 10.1016/j.jep.2016.12.016 PubMed 27974236

Abstract Ethnopharmacological relevance: Evidence on alleviating the risk of lupus nephritis by integrative therapy with conventional medicine (CM) and herbal medicine (HM) had not been addressed.Aim of the study: We investigated the integrative effect associated the risk by a retrospective Systemic Lupus Erythematosus (SLE) cohort from Taiwan National Health Insurance Research Database (NHIRD).Materials and methods: SLE patients with a catastrophic illness certificate (CIC) were retrospectively enrolled from the SLE cohort of the Taiwan NHIRD between 1997 and 2011. The patients were divided into an integrative medicine (IM: integrated CM plus HM) and a non-IM (CM only) group with 1:1 propensity score matching. Cox proportional regression model and the Kaplan-Meier method were conducted to estimate the hazard ratio (HR) for lupus nephritis in the cohort.Results: Among 16,645 newly diagnosed SLE patients holding a CIC (SLE/CIC), 1933 had received HM and 1571 had received no HM treatment. After propensity score matching, there were 273 patients with lupus nephritis-120 in the IM group and 153 in the non-IM group. The adjusted HR (0.68, 95% confidence interval [CI]: 0.54-0.87, p < 0.01) for lupus nephritis was lower in the IM group than in the non-IM group. The adjusted HR (0.69, 95% CI: 0.54-0.88, p < 0.001) for lupus nephritis was also lower in the group of patients who had received CM plus HM than in the group that received CM only. The core pattern of HM prescriptions, which were integrated with CM for preventing lupus nephritis, was Sheng-Di-Huang (raw Rehmannia glutinosa Libosch.), Mu-Dan-Pi (Paeonia suffruticosa Andr.), Dan-Shari (Salvia miltiorrhiza Bge.), Zhi-Bo-Di-Huang-Wan., and Chi-Shao (Paeoniae lactfflorae Rubra).Conclusion: Integrative therapy decreased the risk of lupus nephritis among SLE patients in Taiwan. Further investigation of the pharmacological mechanism and clinical efficacy are warranted.

Species covered 丹参 Salvia miltiorrhiza 牡丹 Paeonia suffruticosa 地黄 Rehmannia glutinosa 芍药属 Paeonia