Qing‐Dai for pediatric ulcerative colitis multicenter survey and systematic review

Abstract

Background Pediatric ulcerative colitis (UC) is more challenging to treat than adult UC. Qing‐Dai therapy is effective in adults but reports of its efficacy in children are unavailable. We conducted a questionnaire survey on Qing‐Dai use among pediatric patients with UC in Japan to determine its efficacy and safety. Methods Questionnaires were sent to 31 high‐volume centers treating pediatric patients with inflammatory bowel disease. The number of patients using Qing‐Dai, short‐term and long‐term effects, and adverse events were assessed. A systematic review of studies on the efficacy and safety of Qing‐Dai usage for UC was also performed. Results Overall, 29/31 facilities (93.5%) responded, Qing‐Dai was used in 107 patients with UC, and 84/107 patients (78.5%) initiated treatment. Within 6 months, 81/101 (80.2%) patients had clinical remission, while 59/92 (64.1%) patients had no relapse and 29/92 (31.5%) experienced only one to two relapses yearly. Eighty‐seven percent of the patients underwent regular follow ups for adverse events, among whom one patient was diagnosed with pulmonary arterial hypertension (PAH), five with enteritis, and one with headache. In the systematic review, the clinical remission rate was 50–80%, and PAH was observed in 14 of 1,158 patients (1.2%). Conclusions Qing‐Dai is highly effective in treating pediatric UC. However, Qing‐Dai should be administered with caution as it may cause adverse events such as PAH.

Real‐world experience with Curcumin–QingDai combination for patients with active ulcerative colitis: A retrospective multicentre cohort study

“…Additionally, we herein report a short follow-up period, restricted to the induction period; however, we and others have reported extended successful experience with these herbal compounds, 11,19,22 including in the paediatric population. 30 Another limitation is the nonsystematic assessment of biomarkers, including missing data and inconsistent timing of testing, and the absence of repeated endoscopic assessments in most patients included.…”

Safety and efficacy of vedolizumab in pediatric patients with ulcerative colitis: multicenter study in Japan

“…Four patients discontinued the therapy due to AEs, and the others discontinued it due to primary failure or a loss of response. The biologic agents were changed to IFX ( n = 1) and UST ( n = 5), whereas herbal remedies such as Quin‐Dai 19 were administered in five, and total colectomy was performed in five after the discontinuation of VDZ. Figure 2 shows the probability of VDZ continuation.…”

Letter by Frumkin Regarding Article, "Dramatically Improved Severe Pulmonary Arterial Hypertension Caused by Qing-Dai (Chinese Herbal Drug) for Ulcerative Colitis."

“…There are 4 additional published cases of PAH believed to be associated with the use of indigo naturalis (also known as Qing-Dai). [3][4][5][6] Indigo naturalis is an herbal medicine derived from fermented leaves and stems of plants and is a component of crude drugs used in traditional Chinese medicine. While indirubin is an active ingredient of indigo naturalis (Qing-Dai), there are numerous ingredients in indigo naturalis (Qing-Dai) that are aryl hydrocarbon receptor (AhR) agonists, and AhR agonism has been associated with the development of pulmonary hypertension in several animal models.…”