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Combination therapies of plant-derived compounds outperform monotherapy for psoriasis vulgaris with specific immunological profilesPlant compounds combined with standard care improve psoriasis symptoms

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Key Takeaway
Consider combination plant-derived therapies to achieve superior PASI reduction and specific immunological profiles.

This systematic review and network meta-analysis evaluated 84 randomized controlled trials involving 7,544 patients with psoriasis vulgaris to compare oral plant-derived bioactive compounds (glycyrrhizin, tripterygium glycosides, and total glucosides of paeony) in monotherapy versus combination therapy. The analysis focused on PASI reduction and several immunological markers including IL-23, IL-17, TNF-alpha, and CD4+/CD8+ ratios.

Combination therapies significantly outperformed monotherapies, with the TG + TOP combination producing the greatest PASI reduction (MD = -13.96; 95% CI -16.88, -11.03) and the highest SUCRA value of 99.80%. Specific combinations demonstrated distinct immunological profiles: CG + TOP was most effective for IL-23 reduction (SUCRA 97.30%), while CG + NB-UVB led in IL-17 reduction (SUCRA 91.20%). TGP + TOP showed the highest SUCRA value of 92.40% for TNF-alpha suppression, and CG + CT best restored CD4+/CD8+ balance (SUCRA 94.70%).

The authors noted limitations including a lack of head-to-head comparisons for individual compounds and the need for long-term confirmation of results. While combination therapies may enhance short-term outcome-specific efficacy, specific immunological benefits vary by compound combination. Long-term safety and efficacy are not confirmed.

How this fits prior evidence

This network meta-analysis addresses a gap in understanding how combining plant-derived compounds like glycyrrhizin (CG) with other agents impacts psoriasis outcomes compared to monotherapy. While prior coverage noted risks associated with licorice intake (glycyrrhizin) such as hypokalemia and hypertension in specific populations, this study focuses on the efficacy of these compounds in combination therapies for psoriasis. The findings suggest that while combinations like TG + TOP show significant PASI reduction (MD = -13.96), long-term safety remains unconfirmed.

Living with psoriasis means dealing with persistent skin inflammation and discomfort. New research looked at how adding certain plant-derived compounds to standard treatments affects the severity of the condition. The study analyzed data from over 7,500 patients across many different trials to see which combinations worked best.

Researchers found that combining these plant ingredients—specifically glycyrrhizin, tripterygium glycosides, and total glucosides of paeony—with standard therapies performed better than using the plant compounds alone. For example, a combination of tripterygium glycosides with topical therapy showed the greatest reduction in skin severity scores. Other combinations were found to be particularly effective at targeting specific immune markers like IL-23 or TNF-alpha.

While these results are promising, there are some important notes. The study did not have many direct head-to-head comparisons between individual compounds, and we still need more long-term data to confirm how well these treatments work over time. Most reported side effects were mild, such as skin dryness or stomach issues.

What this means for you:
Combining specific plant-derived ingredients with standard care can improve psoriasis symptoms more than monotherapy.

Common questions

Are these plant-based treatments safe for people with psoriasis?

The study reported that side effects from these plant-derived compounds were mostly mild. Patients mainly experienced issues like skin dryness or gastrointestinal symptoms. No serious adverse events were recorded in the data reviewed.

How do these combinations compare to using only one treatment?

The research found that combination therapies significantly outperformed monotherapy, which means using just one type of treatment. For example, combining tripterygium glycosides with topical therapy showed the greatest reduction in skin severity scores.

What specific plant ingredients were studied?

The study looked at three specific plant-derived compounds: glycyrrhizin, tripterygium glycosides, and total glucosides of paeony. Each showed different strengths when combined with standard treatments like topical therapy or light therapy.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BackgroundLong-term use of conventional therapy (CT) for psoriasis vulgaris (PV) is often constrained by adverse effects and costs. While oral plant-derived bioactive compounds show clinical promise as adjunctive treatments, the relative efficacy and safety of these compounds and their combination regimens remain poorly defined due to a lack of head-to-head comparisons. This systematic review and network meta-analysis aimed to compare and rank the efficacy and safety of different oral plant-derived bioactive compounds and their combination regimens for PV.MethodsRandomized controlled trials investigating the effects of plant-derived bioactive compounds, such as compound glycyrrhizin (CG), tripterygium glycosides (TG), and total glucosides of paeony (TGP), on PV were retrieved from Chinese and English databases via computer searches. The main outcome measures included the Psoriasis Area and Severity Index (PASI), CD4+/CD8+ ratio, IL-23, IL-17, and TNF-α. Network meta-analysis was performed using Stata 16.0 software.ResultsWe included 84 randomized controlled trials comprising 7,544 patients across 15 treatment regimens. Most combination therapies significantly outperformed monotherapy in PASI reduction. TG combined with topical therapy (TOP) produced the greatest reduction in PASI scores [mean difference (MD) = −13.96, 95% confidence interval (CI) (−16.88, −11.03)], with the highest surface under the cumulative ranking curve (SUCRA) value of 99.80%. Individual compounds showed distinct advantages for specific therapeutic targets. CG + TOP proved most effective for reducing IL-23 levels (SUCRA = 97.30%), while CG + NB-UVB achieved the greatest IL-17 reduction (SUCRA = 91.20%). CG + CT best restored CD4+/CD8+ ratio balance (SUCRA = 94.70%), and TGP + TOP led all regimens in TNF-α suppression (SUCRA = 92.40%). Adverse events were predominantly mild, consisting of gastrointestinal symptoms or skin dryness. No serious or irreversible events were recorded.ConclusionCombining plant-derived compounds with CT may enhance short-term, outcome-specific efficacy. TG + TOP showed the greatest PASI reduction. Immunologically, CG-based regimens optimized IL-23/IL-17 suppression and CD4+/CD8+ normalization, while TGP + TOP maximized TNF-α inhibition. These distinct profiles inform individualized treatment and warrant long-term confirmation.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261304681, identifier (CRD420261304681).
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