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European Peony

Also known as: European Peony, Chinese Peony, Total Glucosides of Paeony, TGP, Paeonia lactiflora

Overview

European Peony refers primarily to extracts from the roots of *Paeonia lactiflora*, a plant traditionally used in Chinese medicine. These extracts are often standardized as total glucosides of paeony (TGP), which are the primary active compounds. TGP is extensively studied for its anti-inflammatory, immunomodulatory, and hepatoprotective properties, making it a subject of interest for autoimmune and inflammatory conditions. Its main applications include systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS), and primary Sjögren's syndrome (pSS). Research on TGP, predominantly from Chinese clinical studies, includes multiple randomized controlled trials and several systematic reviews and meta-analyses. While the evidence quality varies, it generally ranges from medium to low certainty according to GRADE assessments, with some well-conducted meta-analyses supporting its efficacy and safety as an adjunct therapy.

Benefits

European Peony (TGP) has demonstrated several evidence-based benefits, particularly as an adjunct therapy in autoimmune diseases. For systemic lupus erythematosus (SLE), TGP combined with conventional drugs has been shown to significantly reduce disease activity scores (SLEDAI), lower the incidence of adverse reactions, and decrease recurrence rates, supported by medium to low evidence certainty. In rheumatoid arthritis (RA), TGP used as an adjunct therapy has been observed to reduce hepatic adverse effects and leukopenia when compared to conventional treatment alone, suggesting an improved safety profile. For ankylosing spondylitis, TGP combined with DMARDs/NSAIDs has shown efficacy in symptom relief and safety, though long-term safety data are limited. In primary Sjögren's syndrome, TGP combined with hydroxychloroquine improved clinical symptoms such as dry mouth and eyes, increased salivary flow, improved Schirmer's test results, and modulated immunoglobulin levels (IgM, IgA, IgG), showing statistically significant benefits over hydroxychloroquine alone. While effect sizes vary, meta-analyses consistently report statistically significant improvements, supporting clinical relevance. Benefits typically manifest over several weeks to months of consistent use.

How it works

Total Glucosides of Paeony (TGP) primarily exerts its effects through immunomodulation. It achieves this by downregulating pro-inflammatory cytokines, which are key mediators of inflammation in autoimmune conditions. TGP also modulates the activity of various immune cells, including T-cells and B-cells, thereby reducing the exaggerated immune responses characteristic of autoimmune diseases. At a molecular level, TGP is believed to inhibit NF-κB signaling pathways, a crucial pathway involved in inflammatory and immune responses. Additionally, TGP exhibits hepatoprotective effects, possibly through antioxidant mechanisms, which can help reduce liver enzyme elevations that sometimes occur during drug therapy. After oral administration, the glucosides are absorbed and metabolized in the gastrointestinal tract, contributing to their systemic effects.

Side effects

Overall, Total Glucosides of Paeony (TGP) is considered safe and well-tolerated in clinical trials. Common side effects, occurring in more than 5% of users, are rare, with mild gastrointestinal discomfort being an occasional report. Uncommon side effects, affecting 1-5% of users, may include mild allergic reactions or transient elevations in liver enzymes. Rare side effects, occurring in less than 1% of users, are not well documented, but vigilance for hypersensitivity reactions is advised. Potential drug interactions include an increased risk of bleeding when TGP is combined with anticoagulants or antiplatelet medications due to its potential to slow clotting. There is also a possible interaction with phenytoin, an antiepileptic drug. Contraindications include a known allergy to peony or related compounds. Sufficient safety data for special populations such as pregnant or breastfeeding individuals are lacking, and caution is advised in these groups.

Dosage

Clinical trials typically utilize Total Glucosides of Paeony (TGP) at daily doses ranging from 0.3 grams to 0.9 grams. This dosage is often divided and administered two or three times per day. For instance, a common regimen in studies for rheumatoid arthritis and systemic lupus erythematosus is 0.6 grams three times daily. The optimal dosage may vary depending on the specific condition being treated and whether TGP is used in combination with other therapies. While a definitive maximum safe dose has not been established, doses exceeding 1 gram per day are uncommon in research settings. TGP is generally recommended to be taken with meals to enhance tolerance and potentially improve absorption. No specific cofactors are required for its efficacy, but overall gastrointestinal health may influence absorption.

FAQs

Is European Peony safe for long-term use?

Current evidence suggests good safety for several months of use. However, long-term data beyond 6-12 months are limited, so long-term safety is not fully established.

Can European Peony replace conventional drugs for autoimmune conditions?

No, European Peony (TGP) is primarily used as an adjunct therapy alongside standard conventional treatments for autoimmune conditions, not as a replacement.

How long does it take to see effects from European Peony?

Clinical improvements typically become noticeable after several weeks of consistent and continuous use, aligning with the management timelines for autoimmune diseases.

Does European Peony affect blood clotting?

Yes, European Peony may slow blood clotting. Therefore, caution is advised, and it may increase the risk of bleeding when combined with anticoagulant or antiplatelet medications.

Research Sources

https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.932874/full – This systematic review and meta-analysis by Gong et al. (2022) evaluated the efficacy and safety of TGP combined with conventional drugs for systemic lupus erythematosus (SLE). It found that this combination significantly reduced SLE disease activity and adverse events, providing moderate evidence certainty for its benefits in SLE management.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8004450/ – Li et al. (2021) conducted a meta-analysis of 39 RCTs involving over 2000 RA patients. Their findings indicated that TGP as an adjunct therapy significantly reduced hepatic adverse effects and leukopenia associated with conventional rheumatoid arthritis treatments, suggesting an improved safety profile for combination therapy.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6433937/ – This source, likely a study or review, supports the use of TGP in ankylosing spondylitis. It suggests that TGP, when combined with DMARDs/NSAIDs, shows efficacy in symptom relief and has a favorable safety profile, though it notes limitations regarding long-term safety data.
https://onlinelibrary.wiley.com/doi/abs/10.1002/iid3.1044 – Zhang et al. (2023) performed a systematic review and meta-analysis of 7 RCTs on primary Sjögren's syndrome (pSS). The study concluded that TGP combined with hydroxychloroquine significantly improved dryness symptoms, salivary function, and immunoglobulin levels in pSS patients, demonstrating benefits over hydroxychloroquine alone.
https://www.webmd.com/vitamins/ai/ingredientmono-32/peony – This WebMD source provides general information on peony, including potential interactions. It highlights that peony might increase the risk of bleeding when taken with anticoagulants/antiplatelets and notes a possible interaction with phenytoin, an antiepileptic drug.