Effect of topical Andrographis paniculata extracted in end- stage renal disease pruritus: a randomized controlled trial
Abstract
OBJECTIVE
To assess the itching problem in end-stage renal disease (ESRD pruritus) is a common problem for patients and one of the pathogenesis of ESRD pruritus is an inflammation. Many studies support the anti-inflammatory effects of Andrographis paniculata. The research aims to assess the effect of Andrographis paniculata extract in topical form for the treatment of ESRD pruritus.
METHODS
The double-blind randomized controlled trial was conducted. Participants were 44 hemodialytic patients who had ESRD pruritus that were followed up at Chiangrai Prachanukroh Hospital, Thailand from July 1, 2020 to December 31, 2020. The patients were randomized into either Andrographis paniculata extract treatment or placebo. The treatment outcomes were measured by the Dynamic Pruritus Score (DPS) and the Dermatology Quality of Life Index (DLQI) which were assessed after the first and fourth weeks of treatment.
RESULTS
We found that at the end of the 4th week, the Andrographis paniculata extract group had a mean DPS of 7.3±0.8 and a mean DLQI of 0.9±0.9, which was significantly different from the placebo treatment group which had a mean DPS of 5.9±1.1; P<0.01 and a mean DLQI of 3.9±4.4; P=0.03. An adjusted difference of the DPS at the end of the 4th week was 1.50; 95% CI, 0.72–2.28; P<0.01. Patients had neither adverse drug reactions nor dropped out from the study.
CONCLUSION
Andrographis paniculata extract cream could be used to treat ESRD pruritus with low side effects.
References
Berger TG, Steinhoff M. Pruritus and Renal Failure. Semin Cutan Med Surg. 2011; 30(2): 99-100.
Combs SA, Teixeira JP, Germain MJ. Pruritus in Kidney Disease. Semin Nephrol. 2015; 35(4): 383-391.
Shirazian S, Aina O, Park Y, Chowdhury N, Leger K, Hou L, Miyawaki N, Mathur VS. Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges. Int J Nephrol Renovasc Dis. 2017; 10: 11-26.
Makhlough A, Emadi N, Sedighi O, Khademloo M, Bicmohamadi AR. Relationship between serum intact parathyroid hormone and pruritus in hemodialysis patients. Iran J Kidney Dis. 2013;7(1):42-6.
Kimmel M, Alscher DM, Dunst R, Braun N, Machleidt C, Kiefer T, et al. The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients. Nephrol Dial Transpl. 2006;21(3):749–755.
Fallahzadeh MK, Roozbeh J, Geramizadeh B, Namazi MR. Interleukin-2 serum levels are elevated in patients with uremic pruritus: a novel finding with practical implications. Nephrol Dial Transpl.
Simonsen E, Komenda P, Lerner B, Askin N, Bohm C, Shaw J, Tangri N, Rigatto C. Treatment of Uremic Pruritus: A Systematic Review. Am J Kidney Dis. 2017;70(5):638-655.
Malekmakan L, Tadayon T, Pakfetrat M, Mansourian A, Zareei N. Treatments of uremic pruritus: A systematic review. Dermatol Ther. 2018; 31(5): e12683.
Rangkadilok N, Pholphana N, Suriyo T, Satayavivad J. ฟ้าทะลายโจร (Andrographis paniculata) – ข้อมูลวิชาการที่น่ารู้ [Internet]. Bangkok: Chulabhorn Research Institute; 2016 [cited 2020 May 30]. Available from: http://www.eht.sc.mahidol.ac.th/-article/1818
Thisoda, P, Rangkadilok, N, Pholphana, N, Worasuttayangkurn L, Ruchirawat S, Satayavivad J. Inhibitory effect of Andrographis paniculata extract and its active diterpenoids on platelet aggregation. Eur. J. Pharmacol. 2006. 553, 39-45.
Sheeja, K, Shihab, PK, Kuttan G. Antioxidant and anti-inflammatory activities of the plant Andrographis paniculata Nees. Immunopharmacol. Immunotoxicol. 2006, 28, 129-140.
Kumar RA, Sridevi K, Kumar NV, Nanduri S, Rajagopal S. Anticancer and immunostimulatory compounds from Andrographis paniculata. J. Ethnopharmacol. 2004; 92(2-3): 291-5.
Zou W, Xiao Z, Wen X, Luo J, Chen S, Cheng Z, et al. The anti-inflammatory effect of Andrographis paniculata (Burm. f.) Nees on the pelvic inflammatory disease in rats through down-regulation of the NF-κB pathway. BMC Complementary and Alternative Medicine. 2016; 16(1):483.
Li Z, Tan J, Wang L, Li Q. Andrographolide Benefits Rheumatoid Arthritis via Inhibiting MAPK Pathways. Inflammation. 2017; 40(5):1599-1605.
Lee D, Baek CY, Hwang JH, Kim MY. Andrographis paniculata Extract Relieves Pain and Inflammation in Monosodium Iodoacetate-Induced Osteoarthritis and Acetic Acid-Induced Writhing in Animal Models. Processes. 2020; 8(7):873.
Cáceres DD, Hancke JL, Burgos RA, Sandberg F, Wikman GK. Use of visual analog scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of the common cold. A randomized double-blind placebo study. Phytomedicine. 1999; 6: 217-223.
Burgos RA, Hancke JL, Bertoglio JC, Aguirre V, Arriagada S, Calvo M, et al. Efficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms: a prospective randomized placebo-controlled trial. Clinical Rheumatology. 2009; 28(8):931-946.
ประกาศคณะกรรมการพัฒนาระบบยาแห่งชาติ เรื่อง บัญชียาหลักแห่งชาติ พ.ศ. 2563, ราชกิจจานุเบกษาเล่มที่ 137, ตอนพิเศษ 254ง. (ลงวันที่ 29 ตุลาคม 2563).
Al-Bayaty FH, Abdulla MA, Hassan MIA, Ali HM. Effect of Andrographis paniculata leaf extract on wound healing in rats. Natural Product Research,2009; 26(5): 423-429.
Ständer S, Blome C, Anastasiadou Z, Zeidler C, Jung KA, Tsianakas A, et al. Dynamic Pruritus Score: Evaluation of the Validity and Reliability of a New Instrument to Assess the Course of Pruritus. Acta Derm Venereol. 2017; 97(2):230-234.
Noppakun N, Rajatanavin N, Suthipinittharm P, Puvabanditsin P, Akaraphanth R, Tuchinda C, et al. Clinical Practice Guideline for Psoriasis [Internet]. Bangkok: Dermatological Society of Thailand; 2011 [cited 2020 May 30]. Available from: http://www.dst.or.th/files_news/007-Guideline_Psoriasis_2011.pdf
Kulthana K, Jiamton S, Wanitphakdeedecha R, Chantharujikaphong S. The Validity and Reliability of the Dermatology Life Quality Index (DLQI) in Thais. Thai J Dermatol. 2004; 20:113-23
Kulthanan K, Jiamton S, Kittisarapong R. Dermatology Life Quality Index in Thai Patients with Acne. Siriraj Med J. 2007; 59: 3-7.
