Total glucosides of paeony can reduce the hepatotoxicity caused by Methotrexate and Leflunomide combination treatment of active rheumatoid arthritis

Objective: Total glucosides of paeony (TGP) have been confirmed to exert anti-inflammatory and hepatoprotective effects. Methotrexate (MTX) and Leflunomide CLEF) combination has a better efficacy in the treatment of active rheumatoid arthritis (RA), but hepatotoxicity was observed. In this study, we investigated the effect of TGP on hepatic dysfunction caused by MTX and LEF in patients with active RA. Methods: A total of 268 patients with active RA (disease activity score in 28 joints, DAS28 > 32) were enrolled in this study. All patients were randomly assigned to two groups, the therapeutic group in which patients were treated with TGP (1.8 g/day) combined with MTX and LEF (MTX 10 mg/week plus LEF 20 mg/day) while in the control group, patients were treated without TGP up to 12 weeks. The efficacy and liver abnormalities were observed. Results: The incidence of abnormal liver function within 12 weeks in TGP group was significantly lower than that in control group (1138% vs 23.26%, P = 0.013). The proportion of patients with ALT/AST >3 times ULN (upper limits of normal) was significantly lower in TGP group than control group (1.63% vs 7.75%, P = 0.022). More patients achieved remission, good and moderate response in TGP group than control group at 4, 8 and 12 weeks, but the difference was not significant (P > 0.05). The proportions of all adverse events were comparable in the two groups except for diarrhea. Conclusions: Our study demonstrates that TGP can significantly reduce the incidence and severity of liver damage caused by MTX + LEF in the treatment of active RA patients. (C) 2015 Elsevier B.V. All rights reserved.