Low dose oral curcumin is not effective in induction of remission in mild to moderate ulcerative colitis: Results from a randomized double blind placebo controlled trial

Kedia, Saurabh; Bhatia, Vikram; Thareja, Sandeep; Garg, Sushil Kumar; Mouli, Venigalla Pratap; Bopanna, Sawan; Tiwari, Vivekanand; Makharia, Govind; Ahuja, Vineet

doi:10.4292/wjgpt.v8.i2.147

Cited by 67 publications

(71 citation statements)

References 32 publications

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“…A randomized controlled trial by Masoodi et al () reported that the mean SCCAI score was significantly lower in patients who took 240 mg of curcuminoids nanomicelles in addition to mesalamine compared with the control group. On the contrary, Kedia et al () showed that supplementation with curcumin could not improve the clinical outcomes, such as clinical remission, clinical response, and mucosal healing in UC patients. This discrepancy might be associated with the low dose of curcumin (450 mg/day), small sample size, or short duration of the treatment.…”

Section: Discussionmentioning

confidence: 98%

“…In our study, a significant decrease was seen in ESR values among patients who received the curcumin compared to the baseline values and the placebo group. However, a study reported that ESR values did not change with supplementation of 450 mg curcumin after 8 weeks in UC patients (Kedia et al, ). The significant anti‐inflammatory properties of curcumin were represented by improving ESR values in patients with rheumatoid arthritis (Amalraj et al, ).…”

Section: Discussionmentioning

confidence: 99%

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The effect of curcumin supplementation on clinical outcomes and inflammatory markers in patients with ulcerative colitis

Sadeghi

Mansoori

Shayesteh

et al. 2019

Phytotherapy Research

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Background and aims Curcumin has anti‐inflammatory properties. The aim of this study was to evaluate the effect of curcumin on improvement of the disease activity in ulcerative colitis (UC). Methods In this randomized double‐blind clinical trial, 70 patients with mild‐to‐moderate UC were randomly assigned to curcumin (1,500 mg/day) or placebo intake for 8 weeks. Disease clinical activity, quality of life, serum levels of tumor necrosis factor alpha (TNF‐α), high‐sensitivity C‐reactive protein (hs‐CRP), erythrocyte sedimentation rate (ESR) values, and complete blood count were measured. Results Changes in Simple Clinical Colitis Activity Index score were significantly higher in the curcumin than the placebo group (–5.9 ± 2.08 vs. –2.1 ± 2.6; p = .001). The scores of Inflammatory Bowel Disease Questionnaire‐9 and quality of life were significantly higher in the intervention group compared to the control group (p = .006). Furthermore, the curcumin supplementation reduced the serum hs‐CRP concentration (–6.3 ± 13.6 vs. 3.7 ± 11.6 μg/ml; p = .01) and ESR levels significantly (–1.6 ± 2.7 vs. –0.09 ± 2.4 mm/hr; p = .02) in comparison with the control group. No significant changes were observed in the TNF‐α levels of both groups. Conclusions Consumption of the curcumin supplement, along with drug therapy, is associated with significant improvement of the clinical outcomes, quality of life, hs‐CRP, and ESR in patients with mild‐to‐moderate UC.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

The effect of curcumin supplementation on clinical outcomes and inflammatory markers in patients with ulcerative colitis

Sadeghi

Mansoori

Shayesteh

et al. 2019

Phytotherapy Research

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“…Overall evidence suggesting no difference in efficacy of probiotics and mesalamine for both induction and maintenance of remission was rated as low quality due to imprecision (very wide CIs) and high risk of bias (unclear allocation concealment and/or method of randomization) ( Figure 48). [203][204][205] One trial of curcumin enema also showed comparable effect estimates. 206 There was considerable heterogeneity in effect estimates, with 1 trial using curcumin 3 g/d (containing 95% curcuminoid) showing markedly beneficial effect and another trial using low-dose curcumin ( (Table 20).…”

Section: Question 10mentioning

confidence: 87%

AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis

et al. 2019

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Most patients with ulcerative colitis (UC) have mild-tomoderate disease activity, with low risk of colectomy, and are managed by primary care physicians or gastroenterologists. Optimal management of these patients decreases the risk of relapse and proximal disease extension, and may prevent disease progression, complications, and need for immunosuppressive therapy. With several medications (eg, sulfasalazine, diazo-bonded 5-aminosalicylates [ASA], mesalamines, and corticosteroids, including budesonide) and complex dosing formulations, regimens, and routes, to treat a disease with variable anatomic extent, there is considerable practice variability in the management of patients with mild-moderate UC. Hence, the American Gastroenterological Association prioritized clinical guidelines on this topic. To inform clinical guidelines, this technical review was developed in accordance with the Grading of Recommendations Assessment, Development and Evaluation framework for interventional studies. Focused questions included the following: (1) comparative effectiveness and tolerability of different oral 5-ASA therapies (sulfalsalazine vs diazo-bonded 5-ASAs vs mesalamine; low-(<2 g) vs standard (2-3 g/d) vs high-dose (>3 g/d) mesalamine); (2) comparison of different dosing regimens (once-daily vs multiple times per day dosing) and routes (oral vs rectal vs both oral and rectal); (3) role of oral budesonide in patients mild-moderate UC; (4) comparative effectiveness and tolerability of rectal 5-ASA and corticosteroid formulations in patients with distal colitis; and (5) role of alternative therapies like probiotics, curcumin, and fecal microbiota transplantation in the management of mild-moderate UC.

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“…The subgroup analysis of the eligible studies revealed that a better efficacy might be achieved with higher dose, topical enema, special drug form, and longer duration. Only Kedia et al . showed that low dose oral curcumin at a dose of 450 mg/day was ineffective in inducing clinical remission and endoscopic remission.…”

Section: Discussionmentioning

confidence: 99%

“…Curcumin, a polyphenol derived from the turmeric plant ( Curcuma longa ), has been demonstrated to hold many health‐related benefits and pharmacological effects, including anti‐inflammatory, antibacterial actions, and improving symptoms of auto‐immune diseases . Adjuvant use of curcumin in UC has become quite common recently . Multiple animal and human studies suggested that the anti‐inflammatory effect of curcumin in UC was primarily mediated by inhibiting the inflammatory pathways and mediators, such as NF‐κB and TNF‐α .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of adjuvant curcumin therapy in ulcerative colitis: A meta‐analysis of randomized controlled trials

Zheng

Wang

Chen

et al. 2019

J of Gastro and Hepatol

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Background and Aim: Aminosalicylic acids are recognized to be the first-line treatment options for ulcerative colitis. Currently, the effectiveness of curcumin as an adjuvant treatment in ulcerative colitis has been investigated, which was still controversial. This study aimed to systematically review and meta-analyze the efficacy and safety of curcumin as an adjuvant treatment in ulcerative colitis. Methods: The PubMed, EMBASE, and Cochrane Library databases were searched from original to July 2019, and relevant randomized controlled clinical trials were enrolled and analyzed. The primary outcomes were clinical and endoscopic remission; meanwhile, the secondary outcomes were clinical and endoscopic improvement. Subgroup analyses of doses, delivery way, form, and intervention time of curcumin were also conducted. Results: Six randomized controlled clinical trials with a total of 349 patients were included. Eligible trials suggested that adjuvant curcumin treatment in ulcerative colitis was effective in inducing clinical remission (odds ratio [OR] = 5.18, 95% confidence interval [CI]: 1.84-14.56, P = 0.002), endoscopic remission (OR = 5.69, 95% CI: 1.28-25.27, P = 0.02), and endoscopic improvement (OR = 17.05, 95% CI: 1.30-233.00, P = 0.03), but not in clinical improvement (OR = 4.79, 95% CI: 1.02-22.43, P = 0.05). We can see the potential advantages in large dosage, topical enema, special drug form, and longer duration from the enrolled studies. There were no severe side effects reported. Conclusions: Curcumin, as an adjuvant treatment of mesalamine, was proved to be effective and safe in ulcerative colitis. Better efficacy can be achieved with suitable dose, delivery way, formation, and intervention time, which needs further study to verify. Figure 1 The results of the inverted funnel plot analysis of the (a) clinical remission, (b) endoscopic remission, (c) clinical improvement, and (d) endoscopic improvement. [Color figure can be viewed at wileyonlinelibrary.com] T Zheng et al. Effect of curcumin in ulcerative colitis

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Low dose oral curcumin is not effective in induction of remission in mild to moderate ulcerative colitis: Results from a randomized double blind placebo controlled trial

Cited by 67 publications

References 32 publications

The effect of curcumin supplementation on clinical outcomes and inflammatory markers in patients with ulcerative colitis

The effect of curcumin supplementation on clinical outcomes and inflammatory markers in patients with ulcerative colitis

AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis

Efficacy of adjuvant curcumin therapy in ulcerative colitis: A meta‐analysis of randomized controlled trials

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