Results from a systematic review and meta-analysis published in BMC Complementary Medicine and Therapies suggest that acupuncture alone or with concurrent conventional therapy may be more effective treatment strategies than conventional medicine for patients with ulcerative colitis (UC).
The investigators conducted a systematic search of PubMed, the Cochrane Library, Chinese CBM Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database (VIP), and Wanfang Database from the date of each database’s establishment through March 2019 for randomized controlled trials (RCTs) comparing acupuncture with or without conventional therapy to conventional therapy alone for the treatment of UC. The primary outcome measure was “clinical effect,” a composite measure of clinical symptoms, colonoscopy results, and stool examination results. Pooled effect sizes were estimated using risk ratios (RRs).
Data from 13 RCTs were included in the analysis. The pooled study cohort comprised 1030 participants with UC, 515 of whom received acupuncture (treatment group); the remaining 515 received conventional medicine only (control group). Seven RCTs compared acupuncture alone with conventional medicine; 6 compared acupuncture plus conventional medicine with conventional medicine.
The treatment duration ranged from 14 to 60 days. In a pooled cohort of 318 patients from 3 trials with moderate quality evidence per Grading of Recommendations, Assessment, Development and Evaluations criteria, the clinical effect of acupuncture was found to be 1.19 times more effective than concurrent metronidazole and sulfasalazine (RR, 1.19; 95% CI, 1.09-1.31). This finding contrasted with “very low quality evidence” from 200 patients across 3 RCTs that showed that there was “no significant difference between acupuncture and mesalazine on clinical effect,” the study authors said (RR, 1.05; 95% CI, 0.80-1.37).
Mixed results were available for the combined clinical effect of acupuncture and conventional therapy. Compared with mesalazine alone, acupuncture combined with mesalazine was associated with improved clinical effect in a pooled cohort of 232 patients (RR, 1.25; 95% CI, 1.19-1.41). The evidence supporting this deduction was deemed “low quality.” In the meta-analysis, acupuncture combined with mesalazine appeared to have greater colonoscopy curative effect vs mesalazine alone (RR, 1.33; 95% CI, 1.04-1.71; moderate quality evidence; n=108).
Overall, “the clinical effect and colonoscopy curative effective of acupuncture combined with mesalazine were better than that of mesalazine alone [and] the clinical effect of acupuncture alone was better than that of metronidazole combined with sulfasalazine. There was no significant difference in clinical effect between acupuncture alone and mesalazine alone,” the investigators said.
Adverse events were reported in 8 of the 13 RCTs and occurred at similar rates between the acupuncture and control groups, with “no significant differences in the adverse effects,” the investigators said. They specified unclear risk of bias regarding random sequence generation, allocation concealment, incomplete outcome data, and selective reporting as a study limitation. The “generally poor” quality of evidence included in the RCTs was another limitation, the study authors stated.
Although the clinical effect of acupuncture outperformed conventional treatment in some trials, the evidence quality was moderate or low. Therefore, the findings “must be interpreted with caution due to high or unclear risk of bias of the included trials,” the investigators wrote. High-quality RCTs are needed to validate the efficacy and safety of acupuncture for the treatment of UC.
Wang X, Zhao N-Q, Sun Y-X, et al. Acupuncture for ulcerative colitis: a systematic review and meta-analysis of randomized clinical trials. BMC Complement Med Ther. 2020;20(1):309. doi: 10.1186/s12906-020-03101-4