Abstract: Objective To analyze the efficacy and safety of tripterygium wilfordii hook F (TwHF) alone or combination
with acitretin in the treatment of psoriasis vulgaris, and provide evidence-based reference for clinical treatment. Methods
Pubmed, Cochrane, CNKI and Wanfang database were searched up to December 2018. Data of the randomized controlled
trial (RCT) of TwHF alone or in combination with acitretin for psoriasis vulgaris were collected. The primary end-point was
the proportions of patients achieved 60% to 89%, and 90% to 100% improvement in psoriasis area and severity index (PASI) respectively, which were considered as effective rate and cure rate. Adverse drug reactions were analyzed. A systematic review and meta-analysis were conducted for extracted data and quality evaluation by Rev Man 5.3 software. Results A total of 1 258 patients from 13 clinical trials were included in this study. There were no statistically significant differences in effective rate (RR=1.08，95%CI：0.79-1.47，P=0.65) and cure rate (RR=1.22，95%CI：0.67-2.22，P=0.52) between TwHF group (n=284) and acitretin group (n=273). The effective rate (RR=1.48, 95%CI：1.33-1.64, P＜0.01) and cure rate (RR=1.44, 95%CI：1.19-1.75, P＜0.01) were better in TwHF and acitretin combination group (n=368) than those of acitretin group (n=365). Compared with acitretin group, the incidence of gastrointestinal reactions (RR=0.54, 95%CI：0.33-0.91, P＜0.05) and abnormal liver function (RR=0.37, 95%CI：0.18-0.78, P＜0.05) were decreased in the combined group. There were no significant differences in dry skin or mucosa (RR=0.66, 95%CI：0.34-1.27, P=0.21) and elevated blood lipid (RR=0.59, 95%CI：0.31-1.11, P=0.10). Conclusion TwHF can effectively treat psoriasis vulgaris. TwHF combined with acitretin is superior to acitretin monotherapy in the treatment of psoriasis vulgaris.

Key words: psoriasis, Acitretin, Tripterygium wilfordii, Meta-analysis