Abstract

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that predominantly affects females in their 30s to 40s. Approximately 40% of SLE patients develop lupus nephritis (LN), the most common form of secondary glomerulonephritis. Among those with LN, 10-30% progress to end-stage renal disease (ESRD) within 10 years. Due to the chronic and relapsing nature of SLE and LN, many patients require long-term immunosuppressive therapy. However, such treatments are often associated with significant side effects, such as osteonecrosis, bone fractures, cataracts, hyperglycaemia/diabetes, and bone marrow suppression. In view of this, some patients are turning to Traditional Chinese Medicine (TCM) as a complementary or alternative approach, aiming to reduce the dosage of Western medications and alleviate persistent symptoms.

To address concerns about Herb-Drug Interactions (HDIs), we reviewed the pharmacological literature and found that while individual TCM herbs have been shown to affect metabolic enzymes such as cytochrome P450 (CYP450), studies involving TCM formulas—which are typically used in clinical settings—did not demonstrate significant changes in CYP function. Although existing research has identified common biochemical pathways and molecular targets for individual herbs, there is a lack of studies on the interactions and mechanisms of multi-herb formulas commonly used in practice. Nevertheless, current clinical trials suggest that TCM herbs do not compromise the efficacy of Western medications. In fact, comparative studies show that co-management of LN with TCM and Western medicine (WM) yields outcomes at least equivalent to WM alone.

According to TCM theory, SLE is often considered a manifestation of “heat-toxin” or “damp-heat” pathogens, typically arising against a background of “Yin” deficiency – specifically Kidney Yin deficiency in many cases. Consequently, TCM treatment strategies emphasize Yin-nourishing, heat-clearing, and tonifying the kidneys. As many studies focus on patients in the chronic or stable stage of LN, herbal prescriptions also addressed patterns of Qi and Blood deficiency, Spleen deficiency, and Yang deficiency—patterns that may emerge after the acute phase is brought under control.

Overall, most clinical trials indicate that TCM co-management is safe, with no significant increase in adverse event rates compared to WM alone. However, due to variability in outcome measures across studies, a definitive conclusion on the efficacy of TCM remains elusive. SLE Disease Activity Index (SLEDAI) scores did show statistically significant improvements with TCM use, though these improvements may not reach clinical significance. However, patients are able to reduce reliance on glucocorticoids, which may result in cost savings and reduction in glucocorticoid associated side effects in the long run.

In conclusion, while early evidence supports the safety and potential benefits of TCM in LN co-management, more rigorous, standardized clinical trials are needed to fully establish its efficacy and define its role in long-term disease management.  We would like to advocate for a cautious and open-minded approach towards TCM usage in LN patients, emphasizing the importance of regular specialist follow-ups and blood tests, and careful monitoring of symptoms.

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