Steroid-Sparing Effect of Wormwood in Crohn's Disease

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Reviewed: Omer B, Krebs S, Omer H, Noor TO. Steroid-sparing effect of wormwood (Artemisia absinthium) in Crohn's disease: a double-blind placebo-controlled study. Phytomed. 2007;14:87-95.

Crohn's disease (CD) is an ongoing disorder that causes inflammation of the digestive tract. In conventional medicine this disease is usually treated with 5-aminosalicylates, mostly in combination with steroids. Because adverse side effects occur frequently, particularly during the co-treatment with steroids, there is a need for effective steroid-sparing treatment alternatives.

Although the cause of the disease is unknown, recent studies have shown a high prevalence of herpes (such as cytomegalovirus, human herpes virus 6, and Epstein Barr virus) infection in CD patients, and research suggests that these viruses might play a significant role in the pathogenesis of CD. Wormwood (Artemisia absinthium, Asteraceae) herb extract has been shown to possess antiherpes properties, and thus may be a useful additive in the standard treatment of CD. Additionally, CD produces a high psychological burden for patients, and many exhibit symptoms of moderate-to-severe depression. Thus, quality-of-life measures were evaluated during the trial.

The aim of the study was to administer wormwood to patients with CD who were receiving stable doses of corticosteroids, and to determine whether wormwood could reduce the patients' dependence on corticosteroids. The secondary objective of this study was designed to assess whether wormwood would improve symptoms of depression as well as quality-of-life.

Forty patients suffering from CD and receiving stable daily doses of steroids participated in this multicenter, randomized, double-blind trial in Germany. Wormwood, in a proprietary preparation called SedaCrohn®, was obtained from Noorherbals of Hockessin, Delaware, USA. Each 400-mg SedaCrohn capsule contained 250 mg of wormwood powder, 100 mg of rose (Rosa spp., Rosaceae), 40 mg of cardamom seeds (Elettaria cardamomum, Zingiberaceae), and 10 mg of mastic resin.

Wormwood is usually standardized based on absinthin; high-quality wormwood should contain at least 0.2% absinthin.( n1) According to Noorherbals, the SedaCrohn capsules contain 0.2% to 0.38% absinthin and 0.25% to 1.52% essential oils, depending upon the batch. The placebo capsules were physically identical and contained similar amounts of rose-petals, cardamom seeds, and resin of mastic, in addition to 100 mg of starch, all of which lack antiviral activity.

Each group was administered the herbal blend containing wormwood (n=20) or the placebo (n=20) as 3 capsules twice a day for 10 weeks. Patients were assessed for steroid-sparing effects, remission-inducing properties, and quality-of-life improving effects.

After 8 weeks of treatment with wormwood, there was almost complete remission of symptoms in 13 (65%) patients, as compared with none in the placebo group. This remission persisted until the end of the observation period, and the addition of steroids was not necessary.

In the placebo group, 16 patients (80%) showed CD exacerbation due to reduction in steroid dose, whereas there were only 2 (10%) such patients in the wormwood group. The exacerbation of CD symptoms necessitated the resumption of steroids in 11 patients in the placebo group and 2 patients in the wormwood group.

Self-assessment of the patients showed almost no change in subjective feelings of illness in the placebo group, whereas, in the wormwood group the evaluation indicated significant improvement. The patients treated with wormwood reported a gradual improvement in mood that was statistically significant at weeks 10 and 12 (P<0.01).

The results of this study suggest that wormwood may have a steroid-sparing effect, in addition to an effect on the mood and quality-of-life in patients with CD. The authors attribute these effects to viral elimination by wormwood. However, they do not discount that the effect could be due to immune system modulation by wormwood. In addition, no conclusion can be drawn about the psychological findings because the selection of the patients was not based on depression criteria, but on the criteria of CD severity.

The authors conclude that wormwood has not only steroid-sparing effect in patients with CD, but that this effect continues for several weeks after the end of the 10-week treatment period. Also, they suggest that there is a subgroup of patients which is resistant to wormwood treatment, since 5 patients showed little response to the wormwood treatment. Although no definitive conclusion can be drawn from this study, the results warrant further in vitro and in vivo trials in order to understand the observed efficacy of this herb.

Wormwood for Appetite and Weight Loss in Cancer Patients
Editor's Note: the authors of the study on wormwood and Crohn's disease provided the following supplemental report on wormwood research.

The inflammatory process in Crohn's disease (CD) is characterized by increased production of pro-inflammatory cytokines such as tumor necrosis factor (TNF-alpha), interleukin-1, and interleukin-6. In clinical studies, TNF-alpha levels in serum as well as in stool were found to be elevated in patients with active CD in comparison with normal controls. TNF-alpha is now considered to be centrally involved in the inflammatory process in CD. Wormwood suppresses tumor necrosis factor alpha, accelerates healing, and improves mood in patients with CD.

A well known traditional use of wormwood, mentioned in many herb books, is to improve appetite. Almost all cancer patients will suffer at some stage of their illness from poor appetite and weight loss. This symptom has the effect of further deteriorating the condition of cancer patients. It is generally agreed that a well-nourished cancer patient will respond better to anticancer therapy and has better prognosis of illness.

Loss of appetite and weight loss is associated with high levels of TNF-alpha and other immune cytokines. This is the case in cancer patients who are losing appetite and weight.

Large-scale open and double-blind clinical trials are currently being conducted with SedaCrohn on cancer patients experiencing reduced appetite and weight loss. The preliminary results based on the first 40 patients are extremely encouraging. If clinically confirmed, this will give the old fairy (wormwood) a new birth. Although improvement of appetite is one of wormwood's traditional uses, appetite improvement in cancer patients is a new potential benefit.

Source: B. Omer, S. Krebs, H Omer, TO Noor, e-mail to M. Finney, December 5, 2007.

PHOTO (COLOR): Wormwood Artemisia absinthium Photo ©2008 Steven Foster

Reference
(n1.) List PH, Horhammer L. In: Hager's Handbuch der Pharmazeutischen Praxis fur Apotheker, Arzneimittelhersteller, Arzte und Medizinalbeamte, vol 3. Springer, Berlin, Heidelberg, New York. 1973;254-259.

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By Jennifer Minigh, PhD

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