LAUSR

Abstract Introduction We conducted a systematic review and meta-analysis to evaluate the evidence for herbal medicine for inducing or maintaining remission in patients with ulcerative colitis (UC) and Crohn’s disease (CD). Methods Eight databases were searched up to January 2017 for randomised controlled trials of herbal medicine as an adjunct to conventional medication in patients with inflammatory bowel disease (IBD). Data were extracted to obtain risk ratio (RR) of failure of inducing or maintaining remission, with 95% confidence intervals (CI). Risk of bias was assessed using the Cochrane criteria. Results Twenty-nine RCTs (24 UC, 5 CD) were included. In UC, herbal medicine was superior to placebo for clinical remission (RR of remission failure = 0.74, 95% CI: 0.59–0.93; I2 = 62%) and maintaining remission (RR of failure to maintain remission = 0.34, 95% CI: 0.17–0.67; I2 = 0%). Traditional Chinese patent medicine with standard therapy reduced the risk of no comprehensive remission by 19% compared to standard therapy alone (RR of no remission = 0.81, 95% CI: 0.70–0.95; I2 = 0%). In CD, however, the effect of herbal medicine was significant neither for inducing nor maintaining remission (RR of remission failure = 0.57, 95% CI: 0.24–1.33; I2 = 87%; RR of failure to maintain remission = 0.95, 95% CI: 0.60–1.52). Few serious adverse events were reported. Conclusions An adjunctive herbal medicine compared to standard therapy appears effective with few adverse events in achieving and maintaining remission in UC, while there is a lack of supporting evidence for CD. Future high quality trials are warranted.