Use of Curcumin in Achieving Clinical and Endoscopic Remission in Ulcerative Colitis: A Systematic Review and Meta-Analysis

Abstract

Introduction: Ulcerative Colitis (UC) is characterized by chronic inflammation of the mucosal layers of the colon. Treatment of refractory ulcerative colitis is challenging and has a huge healthcare burden. Although there have been advancements in immunomodulatory therapies, these require a step-up financially, and these medications are also associated with significant adverse events. Curcumin, an active ingredient of turmeric, has been studied in the past and found to be useful in the treatment of UC when used as an adjuvant along with mesalamine. We did a systematic review and meta-analysis to explore the role curcumin plays in clinical and endoscopic remission in patients with UC. Methods: A comprehensive literature review was conducted by first searching the MEDLINE, Pubmed, and Embase databases through December 2017 to identify all studies that compared the use of curcumin when used along with mesalamine with placebo for clinical and endoscopic improvement and remission. Eligible studies were required to be randomized controlled trials that had investigated the role of curcumin along with standard of care treatment in ulcerative colitis patients. Studies must report clinical or endoscopic response rates. Studies which only focused on prevention of relapse were excluded. Results: Three randomized controlled trials including 142 patients were included in the study. Out of 142 patients, 71 patients were included in the treatment arm and 71 patients in the placebo arm. We found that the use of curcumin with mesalamine in patients with mild to moderate UC was associated with higher odds of clinical improvement (pooled OR of 4.65, 95% CI: 2.18-9.92, p =0.185) (Figure 2), clinical remission (pooled OR of 6.78, 95% CI: 2.39-19.23, p=0.042) (Figure 3), endoscopic improvement (pooled OR of 3.82, 95% CI: 1.40-10.40, p=0.081) (Figure 4) and endoscopic remission (pooled OR of 12.74, 95% CI: 1.56-104.07, p=0.623) (Figure 5). Only clinical remission reached statistical significance as seen by the p-value 2 of 40.7%. There was no publication bias as seen by the funnel plot diagram138_B Figure 2. forest plot for clinical remission138_C Figure 3. forest plot for endoscopic improvementConclusion: This study demonstrates higher clinical remission rates when Curcumin was used in combination with mesalamine to achieve remission in patients with UC. Curcumin, due to its cost effectiveness and safer side effect profile, can decrease the healthcare burden and morbidity associated with this relapsing and remitting disease.138_A Figure 1. forest plot for clinical improvement