The Efficacy of Curcumin/Qing Dai Combination in Children with Active Ulcerative Colitis: a Multicenter Retrospective Cohort Study

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2024 Oct 15

PMID 39403348

Authors

Nurit Loberman Nachum

Nir Salomon

Anat Yerushalmy-Feler

Yael Weintraub

Dotan Yogev

Maya Granot

Yael Haberman

Shomron Ben-Horin

Batia Weiss

Affiliations

Soon will be listed here.

Abstract

Background: Curcumin and Qing Dai (QD) are herbal extracts that recently showed efficacy in treating inflammatory bowel disease (IBD). Since 2016, a combination of curcumin with QD (CurQD) has been employed in our center for management of active ulcerative colitis (UC).

Objectives: We report the effectiveness and safety of CurQD therapy in children with mild-moderate UC or IBD-unclassified (IBD-U).

Design: A multicenter retrospective study.

Methods: Children aged ≤OP18 years who were treated with CurQD during 2017-2021 were included. Disease activity measures were Pediatric UC Activity Index (PUCAI), and fecal calprotectin (FC). The primary outcome was a decrease in PUCAI by ≥10 points, FC normalization (≤100 µg/gr when baseline ≥300 µg/gr) or a ≥ 50% decrease in FC.

Results: Of 30 patients (60% males, mean age 14 ± 3.9 years), 15 (50%), 13 (43%), and 2 (7%) had pancolitis, left-sided colitis and proctitis, respectively. The daily medication dose was 0.5-3 gm QD with 1-4 gm curcumin. Concomitant treatment at induction was corticosteroids (19%), biologics (28%) and 5-aminosalicylic acid (40%). The mean duration of induction was 11.6 weeks [95% confidence interval (CI) 10.2-13.1, range 8-16]. PUCAI decreased from a mean of 31.3 (95% CI 26.6-36.0, range 5-60) to 10.9 (95% CI 7.6-14.4, range 5-35) ( = 26, < 0.001). FC response and normalization occurred in 11/12 and 7/12 patients, respectively. The median decline in FC was from 749 µg/gm [interquartile range (IQR) 566-1000] to 39 µg/gm (IQR 12-132) ( = 15, = 0.04). During follow-up (median 8 months, IQR 6-10), 10 patients (33%) flared; five of them regained remission or responded to a treatment change. Of 18 patients treated beyond induction, 12 (67%) achieved clinical response and 10 achieved clinical remission by the end of follow up.

Conclusion: CurQD may be effective and safe as an add-on option to conventional management, for induction and maintenance in children with mild-moderate UC/IBD-U.

References

Adachi S, Nakano Y, Kondo T . Risk of Pulmonary Arterial Hypertension During Qing-Dai Use for the Treatment of Ulcerative Colitis. Circ J. 2020; 84(8):1235-1236. DOI: 10.1253/circj.CJ-20-0621. View

Sugimoto S, Naganuma M, Kiyohara H, Arai M, Ono K, Mori K . Clinical Efficacy and Safety of Oral Qing-Dai in Patients with Ulcerative Colitis: A Single-Center Open-Label Prospective Study. Digestion. 2016; 93(3):193-201. DOI: 10.1159/000444217. View

Gaitanis G, Magiatis P, Velegraki A, Bassukas I . A traditional Chinese remedy points to a natural skin habitat: indirubin (indigo naturalis) for psoriasis and the Malassezia metabolome. Br J Dermatol. 2018; 179(3):800. DOI: 10.1111/bjd.16807. View

Bhattacharya A, Osterman M . Biologic Therapy for Ulcerative Colitis. Gastroenterol Clin North Am. 2020; 49(4):717-729. DOI: 10.1016/j.gtc.2020.08.002. View

Gisbert J, Linares P, McNicholl A, Mate J, Gomollon F . Meta-analysis: the efficacy of azathioprine and mercaptopurine in ulcerative colitis. Aliment Pharmacol Ther. 2009; 30(2):126-37. DOI: 10.1111/j.1365-2036.2009.04023.x. View

Naganuma M, Sugimoto S, Mitsuyama K, Kobayashi T, Yoshimura N, Ohi H . Efficacy of Indigo Naturalis in a Multicenter Randomized Controlled Trial of Patients With Ulcerative Colitis. Gastroenterology. 2017; 154(4):935-947. DOI: 10.1053/j.gastro.2017.11.024. View

Suzuki H, Kaneko T, Mizokami Y, Narasaka T, Endo S, Matsui H . Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis. World J Gastroenterol. 2013; 19(17):2718-22. PMC: 3645393. DOI: 10.3748/wjg.v19.i17.2718. View

Lin Y, Chang Y, Hui R, See L, Chang C, Yang C . A Chinese Herb, Indigo Naturalis, Extracted in Oil (Lindioil) Used Topically to Treat Psoriatic Nails: A Randomized Clinical Trial. JAMA Dermatol. 2015; 151(6):672-4. DOI: 10.1001/jamadermatol.2014.5460. View

Lang A, Salomon N, Wu J, Kopylov U, Lahat A, Har-Noy O . Curcumin in Combination With Mesalamine Induces Remission in Patients With Mild-to-Moderate Ulcerative Colitis in a Randomized Controlled Trial. Clin Gastroenterol Hepatol. 2015; 13(8):1444-9.e1. DOI: 10.1016/j.cgh.2015.02.019. View

10.

Kawai S, Iijima H, Shinzaki S, Hiyama S, Yamaguchi T, Araki M . Indigo Naturalis ameliorates murine dextran sodium sulfate-induced colitis via aryl hydrocarbon receptor activation. J Gastroenterol. 2016; 52(8):904-919. DOI: 10.1007/s00535-016-1292-z. View

11.

Yanai H, Salomon N, Lahat A, Ungar B, Eliakim R, Kriger-Sharabi O . Real-world experience with Curcumin-QingDai combination for patients with active ulcerative colitis: A retrospective multicentre cohort study. Aliment Pharmacol Ther. 2023; 58(2):175-181. DOI: 10.1111/apt.17538. View

12.

Ben-Horin S, Salomon N, Karampekos G, Viazis N, Lahat A, Ungar B . Curcumin-QingDai Combination for Patients With Active Ulcerative Colitis: A Randomized, Double-Blinded, Placebo-Controlled Trial. Clin Gastroenterol Hepatol. 2023; 22(2):347-356.e6. DOI: 10.1016/j.cgh.2023.05.023. View

13.

Karthikeyan A, Young K, Moniruzzaman M, Beyene A, Do K, Kalaiselvi S . Curcumin and Its Modified Formulations on Inflammatory Bowel Disease (IBD): The Story So Far and Future Outlook. Pharmaceutics. 2021; 13(4). PMC: 8065662. DOI: 10.3390/pharmaceutics13040484. View

14.

Ford A, Bernstein C, Khan K, Abreu M, Marshall J, Talley N . Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011; 106(4):590-9. DOI: 10.1038/ajg.2011.70. View

15.

Lin Y, Chang C, Chang Y, Wong W, Chang S, Pang J . Clinical assessment of patients with recalcitrant psoriasis in a randomized, observer-blind, vehicle-controlled trial using indigo naturalis. Arch Dermatol. 2008; 144(11):1457-64. DOI: 10.1001/archderm.144.11.1457. View

16.

Hanai H, Iida T, Takeuchi K, Watanabe F, Maruyama Y, Andoh A . Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006; 4(12):1502-6. DOI: 10.1016/j.cgh.2006.08.008. View

17.

Turner D, Otley A, Mack D, Hyams J, de Bruijne J, Uusoue K . Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology. 2007; 133(2):423-32. DOI: 10.1053/j.gastro.2007.05.029. View

18.

Ben-Horin S, Kopylov U, Salomon N . Curcumin-QingDai Combination as Treatment for Moderate-Severe Ulcerative Colitis. Case Rep Gastroenterol. 2023; 16(3):563-568. PMC: 9941783. DOI: 10.1159/000526646. View

19.

Kudo T, Jimbo K, Shimizu H, Iwama I, Ishige T, Mizuochi T . Qing-Dai for pediatric ulcerative colitis multicenter survey and systematic review. Pediatr Int. 2022; 64(1):e15113. DOI: 10.1111/ped.15113. View

20.

Jukic A, Bakiri L, Wagner E, Tilg H, Adolph T . Calprotectin: from biomarker to biological function. Gut. 2021; 70(10):1978-1988. PMC: 8458070. DOI: 10.1136/gutjnl-2021-324855. View