AB0595\u2005CURCUMA LONGA AND BOSWELLIA SERRATA FOR OSTEOARTHRITIS PAIN MANAGEMENT: A LITERATURE REVIEW OF SPECIFIC FORMULATED EXTRACTS FOR COMBINATION

Abstract

The need for safe, effective pain management for osteoarthritis (OA) is important as the number of australian people with OA is expected to grow by 30% from year 2015 to year 2030. Extracts from Boswellia serrata and Curcuma longa are described to have anti-inflammatory and analgesic properties. Clinical studies have also reported efficacy for improving joint pain and stiffness and tolerability. A combination of Boswellia serrata and Curcuma longa formulated extracts might provide benefits in OA pain management.To review the literature describing the efficacy, safety and bioavailability of a formulated Boswellia serrata extract enriched with boswellic acids and a Curcuma longa extract formulated with piperine for OA pain management.PubMed searches for studies reporting efficacy, safety, and/or bioavailability data for Boswellia and Curcumin formulations were conducted on 4 December 2020 with no publication date limitations.For the enriched Boswellia formulation, two clinical studies in OA assessing efficacy and one preclinical bioavailability study were identified1,2,3. For the curcumin formulation, 2 clinical studies were identified4,5. Two double-blind, randomized, parallel, placebo-controlled studies (each N=60) demonstrated significant improvement in Western Ontario and McMaster Universities OA index (WOMAC) pain and stiffness subscale scores in patients with knee OA receiving the enriched Boswellia formulation (100mg/d): In the first study1, a 30-day treatment with enriched Boswellia, compared with placebo, significantly reduced WOMAC pain (−23.6; placebo, −5.6; P<0.0001) and stiffness (−18.8; placebo, −3.4; P=0.0014) scores. Improvement in pain visual analog scale (VAS) score was significant versus placebo at day 5 (P<0.05). In the second study2, A 90-day treatment with enriched Boswellia also significantly improved WOMAC pain (−31.1; placebo, −8.4; P<0.0001) and stiffness (−27.7; placebo, −9.9; P<0.0001) scores versus placebo; Of note, a significant reduction in pain score and functional ability was observed as early as day 7. For the curcumin/piperine formulation, piperine was added to increase the bioavailability of curcumin in humans as established in a comparative bioavailability and pharmacokinetic study4. The results obtained in his study demonstrates that piperine enhances the oral bioavailability of curcumin without side effects. Curcumin/piperine monotherapy (350-400mg curcumin TID) was also shown to significantly reduce WOMAC, VAS and Lequesne’s pain functional index (LPFI) compared to placebo in a randomized double-blind placebo-controlled parallel-group study (N=40)5. In a sub-study that measured inflammatory biomarkers (N=40), there is no significant difference in the magnitude of changes in the inflammatory biomarkers (IL-4, IL-6, hs-CRP, TNF-α, TGF-β and mean ESR between the curcuminoid treatment group and the placebo group (p>0.05)6.Enriched boswellic acid and curcumin/piperine formulations demonstrate efficacy and safety for suitable treatment option: both ingredients, often cited as natural alternatives to address OA pain and stiffness could be evaluated to explore the potential benefit as a formulated combination.[1]Vishal et al. Int. J. Med. Sci. 2011, 8[2]Sengupta et al. Int. J. Med. Sci. 2010, 7[3]Sengupta et al. Mol Cell Biochem. 2011, 354:189-197.[4]Shoba et al. Planta Med. 1998 May;64(4):353-6[5]Panahi et al. Phytother. Res. 28: 1625–1631 (2014).[6]Rahimnia A-R et al. Drug Res 2015; 65: 521–525.Vidhu Sethi Employee of: Employee of GSK Consumer Healthcare, Kamran Siddiqui Employee of: Employee of GSK Consumer Healthcare, Manohar Garg: None declared.