Abstract

Background

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), of which 10-30% progress to end-stage renal disease (ESRD) within 10 years. Traditional Chinese Medicine (TCM) is widely used as an adjunctive therapy. However, there are many concerns regarding herb–drug interactions (HDIs) and clinical evidence regarding efficacy and safety.

Methods

We reviewed published literature to identify associated pharmacological pathways and mechanisms of commonly used TCM herbs and formulas, comparing them to identify potential areas of interaction with conventional drugs before reviewing clinical trials.

Results

Commonly used herbs include Tripterygium wilfordii, Salvia miltiorrhiza, Paeonia suffruticosa, Rehmannia glutinosa, Hedyotis diffusa, and Paeonia lactiflora. The most commonly used formula is Liu Wei Di Huang Wan. Existing literature reveals that individual TCM herbs interact with cytochrome P450 (CYP450), however studies involving TCM formulations did not demonstrate significant changes in CYP function. The TCM herbs show anti-inflammatory and immunomodulatory functions, overlapping with the mechanism of conventional drugs. Clinical evidence suggests that integrated TCM–WM therapy may improve disease activity and renal outcomes without increasing adverse event rates.

Conclusion

Current evidence supports the cautious integration of TCM into multidisciplinary lupus nephritis management. Further studies incorporating standardized clinical outcomes and dedicated herb–drug interaction assessments are required to clarify the role of TCM in modern lupus nephritis care.

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