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We have read the recent paper by Qian-Wen and colleagues on the efficacy of the traditional Chinese medicine Tripterygium wilfordii Hook F (TwHF) alone and in combination with methotrexate (MTX) in patients with rheumatoid arthritis (RA).1
While we have great regard for all the efforts the authors have taken to investigate the efficacy and safety of this interesting compound in patients with RA, we fear that fundamental flaws in the design of the trial and the fallible reporting preclude a balanced interpretation of the otherwise remarkable results.
Our concerns are twofold.
First, it is not clear if the a priori hypothesis underlying this trial includes a non-inferiority comparison of TwHF and MTX, a superiority comparison of TwHF plus MTX versus TwHF or MTX alone, or maybe even both. Unfortunately, the authors do not report a public clinical …