Curcumin-QingDai Combination as Treatment for Crohn’s Disease: A Case Report Open Access

Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract. Transmural involvement of the deeper layers of the bowel wall can be seen in Crohn’s disease (CD), whereby prolonged inflammation can result in progressive damage to the gastrointestinal tract with ensuing complications such as strictures or fistula and abscesses [1]. While there is a plethora of anti-inflammatory and immune-modulating medications available for the treatment of CD, they are associated with some potential side effects and are not universally effective for achieving remission in all patients [1, 2]. Therefore, exploration of additional novel treatments is still warranted.

A plant-based nutraceutical combination of curcumin and QingDai herbal extracts (CurQD) was previously reported to be efficacious in a placebo-controlled trial in patients with active ulcerative colitis [3]. However, whether this nutraceutical may also be beneficial in patients with CD has not been hitherto reported. We herein report on the treatment of a biologic-experienced CD patient with CurQD.

The CARE Checklist has been completed by the authors for this case report, attached as online supplementary material (for all online suppl. material, see https://doi.org/10.1159/000546012).

The patient gave written informed consent for the publication of this report. The patient is a 35-year-old male with colonic CD (L2B1, Montreal classification), who has also had a history of perianal fistulizing disease with recurrent perianal abscesses frequently requiring drainage. He has been receiving infliximab at escalating doses of up to 10 mg/kg every 4 weeks since June 2019. Infliximab was initiated shortly after his diagnosis with perianal CD. His IFX levels were generally supra-therapeutic with levels up to 28 μg/mL. For his perianal disease, he was also a participant in the recent phase 3 darvadstrocel clinical trial with treatment consisting of perianal tract curettage and internal orifice suturing with a stem cell or a placebo injection as part of the trial. A colonoscopy in June 2022 showed complete endoscopic remission (SES CD = 0) on IFX. When assessed in September 2022, he was in symptomatic remission with respect to his intestinal disease activity and his perianal disease was clinically stable.

In November 2022, he was diagnosed with a dilated cardiomyopathy, possibly related to recent COVID myocarditis, although IFX-induced cardiomyopathy could not be definitively excluded [4]. Infliximab was discontinued, also due to consideration of reports suggesting it may be a precipitant of further decompensation or arrhythmias in patients with cardiomyopathy [4, 5]. By June 2023, his CD symptoms had recurred with 2–3 bowel movements/day and some abdominal discomfort and a colonoscopy showed active disease (SES-CD = 16, Fig. 1a). The patient was reluctant to initiate biologic or advanced therapy. On his own, he initiated therapy with an oral CurQD nutraceutical, Evinature (Binyamina, Israel), in June 2023. He used the CurQD yellow protocol, following a regimen of two one-gram tablets administered orally twice a day. In September 2023, 3 months after starting CurQD treatment, he was feeling well with 1–2 bowel movements/day, without blood per rectum or abdominal pain. In January 2024, after 6 months on herbal extract treatment, he underwent a colonoscopy which showed significant mucosal improvement with normal colonic appearances and two small aphthae seen in the terminal ileum, comprising a complete endoscopic remission (SES CD = 3, Fig. 1b). A single perianal fistulous opening was present with no evidence of abscess or significant discharge. The patient was taking no additional prescription or over-the-counter therapy throughout this period. In January 2024, after 6 months of CurQD therapy, normal colonic mucosa was seen on colonoscopy (Fig. 2). He remains in clinical remission as of the time of the preparation of this report.

Despite growing treatment options for CD, including biologics and small molecules, some patients do not adequately respond or experience adverse effects to these advanced therapies. Additionally, high medication costs, even with biosimilars, can limit access to medications in certain areas. Traditional herbal extracts offer a potentially affordable oral option, but their effectiveness often lacks strong scientific backing. The combination of two herbal extracts, CurQD, was previously tested in a placebo-controlled trial in patients with active UC, of whom 48% were biologic experienced, and showed a superiority over placebo in inducing clinical and biomarker endoscopic response and remission. The mode of action is thought to be related to the up-regulation of the mucosal aryl hydro-carbon receptor [3]. A real-world retrospective study from five tertiary centers also demonstrated the efficacy of CurQD when used as an add-on to current medication, including biologics, in refractory UC patients [6]. However, to the best of our knowledge, no data on the use of this nutraceutical in CD patients have been reported to date. The present case may suggest promise for a role for CurQD as an adjunctive treatment in Crohn’s patients. This may be appealing to patients seeking “natural” integrative medicine approaches, which are reasonably affordable and obviate the need for pre-approval, as in the case herein described.

Nonetheless, clinicians should be aware of some uncommon adverse events with QingDai (Indigo) compound, reported mostly in studies performed in Japanese patients, including transient liver transaminases elevations, ischemic colitis and intussusception, and reversible pulmonary hypertension that was reported in several patients taking QingDai at high doses for prolonged duration of times [7]. Although pulmonary hypertension has not been reported with the tapering dose CurQD regimen used in UC [3, 6], careful monitoring of patients on this herbal extract, especially if taking high doses for prolonged times, is still warranted. The use of this nutraceutical in selected patients may be in line with growing recognition by IBD experts and professional associations of the potential benefits of incorporating “holistic” integrative medicine into IBD care, provided they are well evidenced [8‒10]. Future studies are pertinent to corroborate the herein-reported efficacy of CurQD in CD and to explore the relative contribution of each of its components to the clinical outcome observed.

In summary, the present case report describes, for the first time, a possible benefit of CurQD nutraceutical in induction and maintenance of remission in a Crohn’s patient. However, more data, preferably from adequately powered randomized controlled trials, are needed to corroborate these observations.

The authors would like to thank the following individuals for assisting with data curation: Joanne Stempak, Jenny Lee, and Krzysztof Borowski.

Written informed consent was obtained from the patient for publication of the details of their medical case and any accompanying images. This case report was reviewed and ethical approval is not required by the Mount Sinai Research Ethics Board in accordance with local guidelines.

The authors have no conflicts of interest to declare.

This study was not supported by any sponsor or funder.

Netanel Krugliak wrote and edited Introduction, Case Report, and Discussion and contributed to data curation. Mark S. Silverberg wrote and edited Introduction, Case Report, and Discussion and contributed to data curation and supervision.

All data generated or analyzed during this study are included in this article and its online supplementary material files. Further inquiries can be directed to the corresponding author.