Add-on Effect of Total Glucosides of Paeony on Conventional Therapies for Psoriasis: A Systematic Review and Meta-analysis of Randomized Controlled Trial

Ziqing Li ¹ Jie Lu ¹ Kewen Guan ^1* Haiwen Liang ¹ Chuanjian Lu ^1,2* Jingjie Yu ^1,2*

• ¹ Guangzhou University of Chinese Medicine, Guangzhou, China
• ² The Second Affiliated Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China

Background: Psoriasis is an inflammatory and recurrent dermatological disease concurrent with multiple comorbidities. Conventional therapies for psoriasis such as acitretin capsule and narrowband ultraviolet B radiation (NB-UVB) are prone to decreased efficacy and adverse events in longterm application. Total glucosides of paeony (TGP), a plant extract from Radix Paeoniae Alba, has been widely put into clinical practice in conjunction with conventional therapies for psoriasis. This study aims to elucidate the add-on effect of TGP on conventional therapies in the treatment of psoriasis.Methods: Seven databases were searched from their inception to March 2024. Randomized controlled trials (RCTs) concerning TGP concurrent with conventional therapies for psoriasis were included. Risk of Bias 2.0 (RoB 2.0) was used for bias risk assessment and data analysis was conducted with RevMan V.5.4. Evaluation outcomes mainly involved a 60% or greater reduction of Psoriasis area and severity index score (PASI 60) and a 50% or greater reduction of Psoriasis area and severity index score (PASI 50) .Results: This meta-analysis ultimately included 36 RCTs with 3140 participants. The findings indicated that TGP combined with conventional therapies were superior to conventional therapies using alone on PASI 60 (RR = 1.32, 95% CI: 1.25 to 1.39, P < 0.00001) and PASI 50 (RR = 1.44, 95% CI: 1.13 to 1.84, P = 0.004). Several types of conventional therapies were prone to PASI 60 response when combined with TGP than conventional therapies using alone, such as oral medication