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Comment on: ‘Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial’ by Qian-wen et al
  1. Robert B M Landewé1,2,
  2. Désirée van der Heijde3
  1. 1Departments of Rheumatology & Clinical Immunology, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Department of Rheumatology, Atrium Medical Center Heerlen, Heerlen, The Netherlands
  3. 3Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Professor Robert BM Landewé, Rheumatology & Clinical Immunology, Academic Medical Center, Amsterdam, The Netherlands; landewe{at}

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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 …

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  • Contributors RBML and DvdH have both contributed to the design, content and writing of this eletter and have both approved the final version.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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