Wangbi granule + methotrexate + tofacitinib

Wangbi granule + methotrexate + tofacitinib is a combination therapy used for treating rheumatoid arthritis (RA), particularly for patients who have not achieved clinical deep remission with conventional treatments. This combination integrates traditional Chinese medicine (Wangbi granule) with conventional disease-modifying antirheumatic drugs (methotrexate and tofacitinib). ## Drug Information Wangbi granule is a traditional Chinese medicine preparation composed of 16 herbal and 1 animal-based compounds[1][2]. It has shown synergistic effects when used with methotrexate in treating RA patients with "kidney deficiency and dampness" or "stasis blocking channels"[1]. The granule contains numerous active ingredients, including flavonoids, alkaloids, glycosides, coumarins, saponins, phenolic acid, and iridoids[3]. Methotrexate is a conventional disease-modifying antirheumatic drug (DMARD) widely used as first-line therapy for RA. Tofacitinib is a Janus kinase (JAK) inhibitor that helps reduce inflammation and joint damage in RA. The combination therapy is specifically being studied for RA patients who have not achieved deep remission despite using methotrexate and tofacitinib[1]. Clinical trials are evaluating this combination's efficacy and safety through randomized, triple-blind, placebo-controlled studies involving 340 eligible RA patients across six study centers[1]. ## Clinical Outcomes The primary outcome measure for evaluating this combination therapy is the disease activity score derivative for 28 joints (DAS28)[1]. Secondary outcomes include: - American College of Rheumatology 50% response criteria (ACR50) - Fatigue scale-14 (FS-14) - Visual analogue scale for pain (VAS) - Health assessment questionnaire disability index (HAQ-DI) - Biomarkers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)[1] The clinical trials aim to provide strong evidence regarding the efficacy and safety of adding Wangbi granule to conventional RA treatment with methotrexate and tofacitinib, potentially offering a new approach to achieve clinical deep remission in RA patients.