Is herb-partitioned moxibustion and acupuncture efficacious in improving crohn’s disease activity?
Date of publication of randomized controlled trial: August 2014
Design
Randomized controlled trial (RCT).
Participants
92 patients who had a confirmed diagnosis of mild or moderate Crohn’s disease Activity Index (CDAI) values ranging from 151 to 350). They had not taken medications such as salicylic acid drugs and/or prednisone (at a dose ≤ 15 mg) for at least 1 month, and had not taken immunosuppressants or used anti-TNF-α biological agents for 3 months prior to the study enrollment. The reviewers did not report mean age and gender proportion of the participants.
Intervention
Herb-partitioned moxibustion combined with acupuncture treatment was performed three times per week for a duration of 12 weeks. The acupuncture points were ST36, ST37, SP4, SP6, KI3 and LR3; and the moxibustion points were ST25, CV6 and CV12. The treatment course consisted 36 sessions.
Comparator
Comparison: Herb-partitioned moxibustion and acupuncture versus wheat bran-partitioned moxibustion plus superficial acupuncture.
Major Outcomes
Outcome 1: Change in CDAI scores from baseline to week 12. Lower scores indicated a better prognosis than higher scores;
Outcome 2: Change in CDAI scores from baseline to week 24;
Outcome 3: Patients-reported total treatment efficacy measured at the end of treatment;
Outcome 4: Quality of life of the patients measured by the inflammatory bowel disease questionnaire (IBDQ) at the end of treatment.
Settings
This trial was conducted in an outpatient setting.
Comparison    Herb-partitioned moxibustion and acupuncture versus wheat bran-partitioned moxibustion plus superficial acupuncture
Main Results
The CDAI scores of patients in both treatment group and control group significantly reduced by -115.35 ± 55.05 and -35.68 ± 46.91 at week 12. Compared to control group, patients in treatment group demonstrated a significantly larger decrease in CDAI scores at week 12 and week 24. The total treatment efficacy of treatment and control groups were 83.72% and 40.48% respectively. There were statistically significant differences between two groups. The quality of life among patients in the treatment group was significantly better, with a larger increase in IBDQ scores, when compared to control group.
Comparison: Herb-partitioned moxibustion plus acupuncture versus control group for patients with CD
Outcomes (units) No. of studies (Total number of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (85) -115.35 (55.05)/43 -35.68 (46.91)/42 Not applicable as there is only 1 study. Not reported 0.000 Low
2 (NA) 1 (77) -128.93 (64.46)/40 -14.32 (52.09)/37 Not applicable as there is only 1 study. Not reported 0.000 Low
3 (NA) 1 (85) Not reported /43 Not reported /42 Not applicable as there is only 1 study. Not reported 0.000 Low
4 (NA) 1 (85) 24.56 (34.15) /43 9.93 (19.13) /42 Not applicable as there is only 1 study. Not reported 0.017 Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Herb-partitioned moxibustion and acupuncture versus wheat bran-partitioned moxibustion plus superficial acupuncture
Main Results
The CDAI scores of patients in both treatment group and control group significantly reduced by -115.35 ± 55.05 and -35.68 ± 46.91 at week 12. Compared to control group, patients in treatment group demonstrated a significantly larger decrease in CDAI scores at week 12 and week 24. The total treatment efficacy of treatment and control groups were 83.72% and 40.48% respectively. There were statistically significant differences between two groups. The quality of life among patients in the treatment group was significantly better, with a larger increase in IBDQ scores, when compared to control group.
Comparison: Herb-partitioned moxibustion plus acupuncture versus control group for patients with CD
Outcomes (units) 1 (NA) 2 (NA) 3 (NA) 4 (NA)
No. of studies (Total number of participants) 1 (85) 1 (77) 1 (85) 1 (85)
Mean (SD)/ No. of participants Intervention -115.35 (55.05)/43 -128.93 (64.46)/40 Not reported /43 24.56 (34.15) /43
Comparator -35.68 (46.91)/42 -14.32 (52.09)/37 Not reported /42 9.93 (19.13) /42
MD (95% CI) Not reported Not reported Not reported Not reported
p value 0.000 0.000 0.000 0.017
Overall quality of evidence* Low Low Low Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Conclusion
Benefits
This study showed that herb-partitioned moxibustion plus acupuncture may provide significant effect in treating CD and improving quality of life among patients with CD when compared to control. For all outcomes, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
A total of two adverse events were reported during the trial. One patient in treatment group experienced pain or subcutaneous hematoma during acupuncture and one in control group received a mild burn during wheat bran-partitioned moxibustion. No other serious adverse events were reported.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25152604
The synopsis is based on the following article:
Bao CH, Zhao JM, Liu HR, Lu Y, Zhu YF, Shi Y, et al. Randomized controlled trial: moxibustion and acupuncture for the treatment of Crohn’s disease. World J Gastroenterol. 2014 Aug 21;20(31):11000-11.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.