Efficacy and safety of Tripterygium agents in treatment of psoriasis: a systematic review and network meta-analysis.

BACKGROUND

Psoriasis is a chronic inflammatory disease characterized by skin plaques and scaling. Tripterygium, a traditional Chinese medicinal herb, has been developed into a variety of agents for the treatment of psoriasis; however, its efficacy, safety, and optimal treatment regimen remain unclear.

OBJECTIVE

To summarize the efficacy and safety of Tripterygium agents in the treatment of psoriasis and compare monotherapy with combination therapy.

METHODS

Five databases were searched up to June 30, 2025. R software version 4.3.3 with the "meta" and "Gemtc" packages were used for the data analysis.

RESULTS

Forty-three trials were included in the analysis. A meta-analysis showed that TwHF agent combination therapy reduced the Psoriasis Area and Severity Index (PASI) score (mean difference [MD], -3.96; 95% confidence interval [CI], [-5.57, -2.35]; p<0.01) and elevated the total effective rate (odds ratio, 3.02; 95% CI, [2.44, 3.74]; p<0.05), whereas monotherapy of Tripterygium agent showed no significant difference. Adverse events were also observed with combination therapy. Among the combined treatments, Tripterygium glycoside (TG) + acitretin (ACI) (98.41%) ranked first at improving the PASI score, followed by TG + compound glycyrrhizin injection (71.13%) and TG + DiYin capsule (51.30%).

LIMITATIONS: All included studies were published in Chinese or English, causing a degree of selection bias.

CONCLUSION

Tripterygium agents combination therapy, especially TG+ACI (SUCRA 98.41%), is effective for psoriasis but associated with some adverse events. Further studies should focus on toxicity reduction and expanding clinical options.