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

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

doi:10.1016/j.jep.2016.12.016

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

J Ethnopharmacol. 2017 Jan 20:196:201-212. doi: 10.1016/j.jep.2016.12.016. Epub 2016 Dec 12.

Authors

Ching-Mao Chang¹, Po-Chang Wu², Jen-Huai Chiang³, Yau-Huei Wei⁴, Fang-Pey Chen⁵, Tzeng-Ji Chen⁶, Tai-Long Pan⁷, Hung-Rong Yen⁸, Hen-Hong Chang⁹

Affiliations

¹ Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Graduate Institute of Clinical Medicine, and Graduate Institute of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
² Division of Rheumatology and Immunology and Department of Education, China Medical University Hospital, Taichung, Taiwan, ROC.
³ Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, ROC; College of Medicine, China Medical University, Taichung, Taiwan, ROC; Graduate Institute of Integrated Medicine, College of Chinese Medicine, Taichung, Taiwan, ROC.
⁴ Department of Biochemistry and Molecular Biology, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medicine, Mackay Medical College, New Taipei, Taiwan, ROC.
⁵ Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
⁶ Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
⁷ School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC; Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
⁸ Research Center for Chinese Herbal Medicine, and School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, ROC; Departments of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan, ROC; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC. Electronic address: hungrongyen@gmail.com.
⁹ Research Center for Chinese Herbal Medicine, and School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, ROC; Research Center for Chinese Medicine & Acupuncture, and School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, ROC; Departments of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan, ROC. Electronic address: tcmchh55@gmail.com.

PMID: 27974236
DOI: 10.1016/j.jep.2016.12.016

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-Shan" (Salvia miltiorrhiza Bge.), "Zhi-Bo-Di-Huang-Wan.", and "Chi-Shao" (Paeoniae lactiflorae 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.

Keywords: Complementary and alternative medicine; Herbal medicine; Integrative therapy; Lupus nephritis; Systemic lupus erythematosus.

MeSH terms

Adolescent
Adult
Drugs, Chinese Herbal / therapeutic use*
Female
Humans
Lupus Erythematosus, Systemic / drug therapy*
Lupus Erythematosus, Systemic / epidemiology
Male
Middle Aged
Phytotherapy* / statistics & numerical data
Retrospective Studies
Taiwan / epidemiology
Treatment Outcome
Young Adult

Substances

Drugs, Chinese Herbal