Curcumin is said to have immunoregulatory properties, to reduce oxidative stress, to promote mucosal healing, to protect the intestinal barrier, and to inhibit autophagy and antifibrotic actions, but poor oral bioavailability has limited its clinical application.
Dr. Rupa Banerjee of Asian Institute of Gastroenterology, in Hyderabad, India, and colleagues examined the efficacy of a bioenhanced version of curcumin (Valdone from Cadila Pharmaceuticals Ltd., in India) in inducing clinical remission in their randomized, double-blind, placebo-controlled study of 69 patients with mild-to-moderate active disease who had been taking maximal doses of oral and rectal mesalamine for at least four weeks.
During the three-month study, four of 34 patients from the curcumin group and three of 35 patients from the placebo group discontinued therapy.
The rate of clinical remission, the primary outcome, was 44.1% (15/34) in the curcumin group versus none (0/35) in the placebo group at week 6 (P<0.01). The clinical remission rate remained significantly higher in the curcumin group at three months (55.9% vs. 5.7%).
Endoscopic remission rates were also higher in the curcumin group than in the placebo group at six weeks (35.3% vs. 0%) and three months (44% vs. 5.7%), the researchers report in the Journal of Clinical Gastroenterology.
The rate of clinical response, defined as a decrease of at least two points of partial Mayo score from baseline, was also significantly higher in the curcumin group than in the placebo group at six weeks (52.9% vs. 14.3%) and at three months (58.8% vs. 28.6%).
In the curcumin group, 18 of 19 patients who achieved clinical remission maintained both clinical and endoscopic remission at six months, compared with none of the patients in the placebo group.
"We have shown that low-dose bioenhanced curcumin as add-on therapy was superior to placebo in inducing clinical and endoscopic remission in mild-to-moderate ulcerative colitis (UC) with minimal adverse effects," the authors conclude. "This could potentially reduce the need for the traditional second-line therapies with immunomodulators and biologics, which are associated with an increased risk of adverse events, particularly infectious complications in addition to bone marrow suppression and malignancy."
"This is particularly relevant in the TB endemic regions of the world where TB and reactivation of latent TB have been of particular concern," they note. "In addition, curcumin is a safe low-cost treatment option especially in resource-limited settings. As the global burden of IBD increases, curcumin may present a cost-effective alternative for the management of UC."
The authors report no funding or conflicts of interest.
Dr. Banerjee did not respond to a request for comments.
By Reuters Staff
SOURCE: https://bit.ly/363n4rj Journal of Clinical Gastroenterology, online September 4, 2020.
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