NEW YORK (Reuters Health) Aug 17 - The Chinese herb Tripterygium wilfordii Hook F (TwHF) is more effective than sulfasalazine for treating rheumatoid arthritis (RA), according to a report in the August 18th Annals of Internal Medicine.
"The mechanism of action is not fully understood but seems different from currently available drugs," Dr. Raphaela Goldbach-Mansky, from the National Institutes of Health, Bethesda, Maryland told Reuters Health. "Although a standardized preparation of the drug is not currently available, the treatment with TwHF may become an addition to the currently available treatment options for RA in the future."
Dr. Goldbach-Mansky and colleagues compared TwHF extract with sulfasalazine in a 24-week study of 121 patients with active rheumatoid arthritis who could continue oral prednisone and nonsteroidal anti-inflammatory drugs but not disease-modifying antirheumatic drugs.
Significantly more patients treated with TwHF (67.57%) than treated with sulfasalazine (36.00%) achieved at least a 20% improvement in disease activity as determined by the ACR20 response, the authors report.
Similar differences were seen in their ACR50 and ACR70 responses, the researchers note.
The mean improvement in the Disease Activity Score 28 was also higher in the TwHF group (2.40 points) than in the sulfasalazine group (1.50).
Health Assessment Questionnaire (HAQ) disability improvements were significantly greater in the TwHF group as early as 2 weeks into the treatment, the researchers note, and improvements persisted throughout the study for HAQ disability assessment, pain, the patient's and physician's global assessment of health, erythrocyte sedimentation rate, and C-reactive protein.
Patients in the TwHF group experienced less radiographic progression than did patients in the sulfasalazine group, although the differences were not statistically significant.
Reductions in interleukin-6 and rheumatoid factor were more pronounced in the TwHF group than in the sulfasalazine group.
Adverse events occurred with similar frequency in the 2 treatment groups, the investigators say, but more patients in the sulfasalazine group experienced adverse events classified by the investigator as moderate to severe.
"A study to use TwHF in combination with methotrexate should be done," Dr. Goldbach-Mansky said. "As the presumed mechanisms of action differ between methotrexate and TwHF, we would hypothesize that the two therapies might synergize in the treatment of RA."
"As TwHF is a plant extract it may be an affordable treatment option in countries where the expensive biologic therapies can not be afforded," Dr. Goldbach-Mansky added. "Understanding the mechanism of action of TwHF in RA may reveal potential new targets for drug development."
Ann Intern Med 2009;151:229-240.
Wow! This sure sounds great... wonder if there were side effects and if this is an ongoing study?