Abstract
Curcumin has demonstrated anti-inflammatory properties and has been investigated as an adjuvant therapy of ulcerative colitis (UC). The scope of this study was to systematically review and meta-analyze the efficacy of oral curcumin administration as an adjuvant therapy of UC. MEDLINE, Cochrane/CENTRAL, ClinicalTrials.gov, WHO-ICT Registry, EMBASE and grey literature were searched for relevant randomized controlled trials (RCTs). The primary outcome was clinical remission (attainment) and the secondary outcome was clinical response (maintenance/failure). Risk of bias was assessed with the Cochrane tool. Odds ratios (OR) were calculated with a Mantel-Haenszel (M-H) random effects model and with a beta-binomial (B-B) random effects model when zero events/cells occurred. Four RCTs met the criteria, but one was removed from the analyses due to inconsistency in protocol details. With the M-H method, treatment with curcumin was significantly superior to placebo in attaining remission in the per-protocol (PP) analysis (OR = 5.83, 95%CI = 1.24–27.43), but not in the intention-to-treat (ITT) analysis (OR = 4.33, 95%CI = 0.78–24.00). However, with the more accurate B-B method, both analyses were insignificant (for PP OR = 4.26, 95%CI = 0.59–31.00, for ITT OR = 3.80, 95%CI = 0.55–26.28). Based on the current available evidence, oral curcumin administration does not seem superior to placebo in attaining remission in patients with UC. Future RCTs should be planned more cautiously with sufficient size and adhere to the ITT analysis in all outcomes.
Highlights
Inflammatory bowel disease (IBD) is a blanket term used to define chronic inflammatory conditions of the colon and small intestine
Among the most promising recent therapeutic advances, curcumin, a polyphenol derived from the turmeric plant (Curcuma longa) has been suggested to yield many health-related benefits and pharmacological effects, including its anti-inflammatory [9] and antibacterial actions [10], the ability to improve symptoms of auto-immune diseases [11,12], ameliorate lipidemic profiles [13], and improve vascular endothelial function [14]
The selected primary outcome of the analysis was the proportion of patients attaining remission, as defined by a decreased disease-specific activity score, such as the colitis activity index (CAI) [19], simple clinical colitis activity index (SCCAI) [20], or ulcerative colitis disease activity index (UCDAI) [21]
Summary
Inflammatory bowel disease (IBD) is a blanket term used to define chronic inflammatory conditions of the colon and small intestine. Though the etiology behind IBD development and UC in particular is still uncertain [2], its treatment is based on a comprehensive approach including lifestyle, diet [3,4,5] and prescription of top-down biologic therapy [6]. Among the most promising recent therapeutic advances, curcumin, a polyphenol derived from the turmeric plant (Curcuma longa) has been suggested to yield many health-related benefits and pharmacological effects, including its anti-inflammatory [9] and antibacterial actions [10], the ability to improve symptoms of auto-immune diseases [11,12], ameliorate lipidemic profiles [13], and improve vascular endothelial function [14]. UC-specific postulated effects of curcumin use include significantly reduced disease activity indices [17,18], lower endoscopic activity scores [15,17], as well as improved erythrocyte sedimentation rate (ESR), a reliable systemic inflammatory marker [17]
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