Article - Efficacy and safety of curcumin therapy for knee osteoarthritis: A Bayesian network meta-analysis.

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Take home message

Curcumin significantly reduces pain (VAS score) and joint symptoms (WOMAC score) compared to placebo.
It is effective alone or in combination with NSAIDs or CP, with curcumin + CP ranking best for pain relief.
Curcumin demonstrates clinical value, but further clinical studies are needed to confirm its long-term benefits and optimal drug combinations.

Evidence category

A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)

Summary review

Introduction

The aim of this systematic review with meta-analysis was to evaluate the efficacy and safety of curcumin, both alone and in combination with other drugs, in Knee Osteoarthritis (KOA) treatment through a Bayesian network meta-analysis.

Methods

Randomised controlled trials of oral curcumin for KOA treatment were sought from PubMed, Embase and Cochrane from establishment of the database to April 2023.
Participants in the control groups could take placebo, Chondroprotective drugs (CP), and non-steroid anti-inflammatory drugs (NSAIDs) orally.
Included studies needed to report one of the following outcomes: visual analogue scale (VAS) pain score, a specific Osteoarthritis Index (WOMAC) score, use of rescue medication (RM), or adverse events (AE).
This study followed PRISMA guidelines and is registered with PROSPERO.
The Bayesian network meta-analysis utilised a random effects model.

Results

23 studies met the inclusion criteria, which included a total of 2175 KOA patients and 6 interventions: 1) curcumin, 2) CP, 3) curcumin + CP, 4) curcumin + NSAIDs, 5) NSAIDs and 6) placebo. The methodological quality of the included papers was considered acceptable, with the majority deemed low risk.
Curcumin significantly reduced the visual analogue scale (VAS) pain score compared to placebo (MD = -1.63, 95% CI: -2.91 to -0.45).
Curcumin also significantly reduced the total WOMAC pain score compared to placebo (MD = -18.85, 95% CI: -29.53 to -8.76).
Curcumin reduced the need for rescue medication (OR = 0.17, 95% CI: 0.08 to 0.36).
Curcumin + NSAIDs significantly lowered the need for rescue medication (OR = 0.01, 95% CI: 0.00 to 0.13).
NSAIDs alone also reduced rescue medication use (OR = 0.11, 95% CI: 0.02 to 0.47).
Curcumin had a lower incidence of AE's (OR = 0.51, 95% CI: 0.25 to 0.94).
Curcumin + NSAIDs also showed a reduced incidence of AE's (OR = 0.23, 95% CI: 0.06 to 0.9).
Curcumin monotherapy, curcumin + chondroprotective agents (CP), and curcumin + NSAIDs have strong clinical value in treating KOA.

Conclusion

The combination of curcumin with NSAIDs or CP may increase the anti-inflammatory and analgesic pharmacological effects and reduce adverse reactions.

Clinical practice applications

Curcumin supplementation should be considered in KOA cases, including in combination with other treatments.
There were differences in the curcumin products used in the included studies, but doses ranged from 100 to 2000mg/day.
Duration of interventions of included studies ranged from 4 weeks to 4 months.

Considerations for future research

Further clinical research should be undertaken to verify the findings of these results.
Research should compare efficacy of different forms of curcumin supplementation.
Pharmacological mechanisms of curcumin in treating KOA should be studied.

Abstract

ETHNOPHARMACOLOGICAL RELEVANCE

Curcumin, a polyphenolic compound extracted from turmeric (Curcuma longa L.), is widely used in traditional Chinese medicine to treat osteoarthritis and rheumatoid arthritis. Clinical and experimental studies show that curcuminoid formulations have considerable clinical application value in the treatment of knee osteoarthritis (KOA).

AIM OF THE STUDY

To evaluate the efficacy and safety of curcumin, both alone and in combination with other drugs, in KOA treatment through a Bayesian network meta-analysis (NMA).

METHODS

We searched PubMed, Embase and Cochrane Library for randomized controlled trials of curcumin for KOA treatment. The time range of the search was from the establishment of each database to April 26, 2023. The NMAs of outcome indicators were all performed using a random-effects model. NMAs were calculated and graphed in R using MetaInsight and Stata 140 software. Measurement data were represented by the mean difference (MD), while count data were represented by the odds ratio (OR); the 95% confidence interval (CI) of each effect size was also calculated.

RESULTS

This study included 23 studies from 7 countries, including 2175 KOA patients and 6 interventions. The NMA results showed that compared with placebo, curcumin significantly reduced the visual analogue scale pain score (MD = -1.63, 95% CI: -2.91 to -0.45) and total WOMAC score (MD = -18.85, 95% CI: -29.53 to -8.76). Compared with placebo, curcumin (OR = 0.17, 95% CI: 0.08 to 0.36), curcumin + NSAIDs (OR = 0.01, 95% CI: 0.00 to 0.13) and NSAIDs (OR = 0.11, 95% CI: 0.02 to 0.47) reduced the use of rescue medication. Compared with NSAIDs, curcumin (OR = 0.51, 95% CI: 0.25 to 0.94) and curcumin + NSAIDs (OR = 0.23, 95% CI: 0.06 to 0.9) had a reduced incidence of adverse reactions. The surface under the cumulative ranking curve results indicated that curcumin monotherapy, curcumin + chondroprotective agents, and curcumin + NSAIDs have good clinical value in KOA treatment.

CONCLUSIONS

Curcumin, either alone or in combination with other treatments, is considered to have good clinical efficacy and safety in KOA treatment. Drug combinations containing curcumin may have the dual effect of enhancing efficacy and reducing adverse reactions, but this possibility still needs to be confirmed by further clinical and basic research.

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