Written by Greg Arnold, DC, CSCS. Andrographis paniculata extract was as effective as the drug mesalazine in bringing complete or partial remission to those study participants suffering from ulcerative colitis.
Ulcerative colitis is a chronic inflammatory disease of the colon of unknown origin (1) Because of its inflammatory basis, initial (first-line) therapies focus on decreasing the inflammation with medications that contain aspirin as well as medications called mesalazine, sulfasalazine, balsalazide and olsalazine (2, 3). These first-line therapies help half of those suffering from ulcerative colitis (4).
When first-line therapies fail, more potent anti-inflammatory medications such as steroids (5), azathioprine (5), and infliximab (7) are administered. But because these second-line therapies bring with them increased risks of infection and cancer (8), more natural therapies without severe side effects are needed.
A 2011 study (9) involved 108 men and women aged 18 to 65 with mild-to-moderate ulcerative colitis. They were given either 1200 milligrams per day of an extract of the plant Andrographis paniculata (55 subjects), widely used in Asian countries as well as in Sweden and Chile to treat a variety of inflammatory and infectious diseases (10), or 4,500 milligrams of mesalazine for 8 weeks (53 subjects). No placebo group was used.
Before the study began and every two weeks until the end of the study, ulcerative colitis severity was assessed. This was done by administering a colonoscopy, obtaining tissue samples, and assessing symptoms through previously used methods that classified symptoms on a grade from “0” (normal rectal lining) to “4” (presence of ulcers, mucus, and pus) (11).
At the end of eight weeks, 21% of those in the extract group and 16% of those treated with mesalazine were classified as being in remission, and 36% of those in both groups was classified as being in partial remission. When looking at the overall effectiveness of the treatment (“efficacy”), 76% of those in the plant extract group and 82% of those in the mesalazine group had a greater than 25% reduction in symptoms (p < 0.01).
Regarding the tissues samples, 28% of those in the plant extract group and 24% of those in the mesalazine group were in remission (no inflammation present, p < 0.01). Regarding partial remission, where ulcerative colitis severity in the cells had decreased by at least 2 grades (“4” to “2”, “3” to “1”, or “2” to “0”), a 19% decrease was observed in the plant group compared to an 18% decrease in the mesalazine group (p < 0.01). Overall efficacy (comprising complete/partial remission or “improvement”) was 74% in the plant group and 71% in the mesalazine group (p < 0.01).
Regarding side effects, 13% of those in the plant extract group and 27% of those in the mesalazine group had at least one adverse event, with “a majority of adverse events being mild or moderate in severity and doubtfully related to the study medication.” Seven patients (2 in the plant group, 5 in the mesalazine group) had to withdraw from the study due to severe side effects, including hospitalization due to an increase severity of their ulcerative colitis.
For the researchers, the plant extract of Andrographis paniculata “could serve either as a substitute for induction therapy with mesalazine, or be successfully used as induction therapy in those patients with a suboptimal response to mesalazine.”
Source: Tang, T., et al. “Randomised clinical trial: herbal extract HMPL‐004 in active ulcerative colitis–a double‐blind comparison with sustained release mesalazine.” Alimentary pharmacology & therapeutics 33.2 (2011): 194-202.
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Posted January 28, 2016.
Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com
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- Tang T. Randomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis – a double-blind comparison with sustained release mesalazine. Aliment Pharmacol Ther 2011 Jan;33(2):194-202. doi: 10.1111/j.1365-2036.2010.04515.x. Epub 2010 Nov 30
- Zhu HF. Clinical and experimental studies on minor prescription of bupleurum Chinese (Xiao Chaihu Tang) for ulcerative colitis. Zhonggo Gagchangbing Za Zhi 2003; 23: 19–21
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