BETHESDA, Maryland—Thunder god vine may be the first traditional Chinese medicine to make a big noise in rheumatoid arthritis (RA) care. According to data reported by Raphaela Golbach-Mansky, MD, and colleagues in Annals of Internal Medicine, the herb produced significantly more ACR 20 responses than sulfasalazine after 24 weeks of treatment.1
Dr. Golbach-Mansky told Musculoskeletal Report, “This treatment is used in China for patients with rheumatoid arthritis. I am not aware of any other countries where the extract is currently used. When drug development has reached a level of approval, this oral treatment might be an attractive and affordable choice to treat RA patients in developing countries.”
Researchers from 2 US academic centers and 9 rheumatology subspecialty clinics randomized 121 patients who had active RA and 6 or more painful and swollen joints. Patients received either sulfasalazine, 1g twice daily, or an extract of Tripterygium wilfordii Hook F (TwHF, also known as thunder god vine or lei gong teng), 60mg three times daily. All patients stopped disease-modifying antirheumatic drugs (DMARDs) at least 28 days before randomization, but they could continue stable doses of oral prednisone or NSAIDs.
Thunder god speaks: high efficacy, low toxicity
The primary outcome was the rate of achieving 20% improvement in the American College of Rheumatology criteria (ACR20) at 24 weeks.
Half of the patients dropped out, and this paper reports outcome data for 62 patients at 24 weeks (37 on TwHF, 25 on sulfasalazine. Over twice as many patients discontinued sulfasalazine for adverse events as discontinued TwHF for adverse events (17 vs. 7, P=0.039). Thirteen in the sulfasalazine and 5 in the TwHF group discontinued due to lack of efficacy.
A mixed-model analysis that imputed data for dropouts showed ACR20 responses in 65.0% of TwHF patients vs. 32.8% of sulfasalazine patients (P=0.001). TwHF also produced more ACR50 and ACR70 responses.
“Significant improvement was demonstrated in all individual components of the ACR response, including the Health Assessment Questionnaire disability score. Interleukin-6 levels rapidly and significantly decreased in the TwHF group. Although not statistically significant, radiographic progression was lower in the TwHF group,” the authors write.
Dr. Raphaela Goldbach-Mansky, who is in the Translational Autoinflammatory Disease Section at the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, MD, said that adverse effects were similar with the two treatments. She also said that the researchers were surprised at some of the rapid responses seen.