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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

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Frankincense: systematic review

.

Review published: .

CRD summary

The author concluded that Boswellia serrata extracts appear to be effective in treating a range of conditions caused or maintained by inflammatory processes. However, the evidence is encouraging rather than convincing and further research is warranted. Apart from some limitations in the methods, this was a well-conducted review and the author's conclusions are likely to be reliable.

Authors' objectives

To summarise the evidence on the effectiveness of Boswellia serrata (frankincense) extracts.

Searching

The following databases were searched from inception to August 2008: AMED, CINAHL, EMBASE, MEDLINE and the Cochrane Library. Search terms were reported. Departmental files including conference proceedings and bibliographies were also searched. No language restrictions were applied.

Study selection

Randomised controlled trials (RCTs) were eligible for this review if they compared mono preparations of Boswellia serrata (B. serrata) with another intervention using a randomised trial design. Any patients were eligible regardless of medical condition.

All of the included trials compared B. serrata taken orally (100mg to 400mg per day) with placebo or another intervention. Most trials were conducted in India. The conditions treated ranged from asthma, osteoarthritis and rheumatoid arthritis to inflammatory conditions such as Crohn's disease or collagenous colitis. Reported outcomes included disease specific measures, visual analogue pain scales and numbers of patients showing improvement. The duration of interventions ranged from 90 days to six months.

Studies were selected by the author.

Assessment of study quality

Two reviewers independently applied the Jadad scale for methodological quality which includes items on randomisation, allocation concealment, blinding and reporting of withdrawals and drop-outs.

Data extraction

Data were extracted by the author.

Methods of synthesis

Results were presented in a narrative form and tabulated.

Results of the review

A total of seven RCTs were included in this review (n=421), with sample sizes ranging from 30 to 102. Five were placebo controlled RCTs and two trials were comparisons with alternative active interventions. The methodological quality was variable but three trials scored the maximum possible on the Jadad scale.

Boswellia extracts showed some positive results in the treatment of asthma (1 trial versus placebo, n=80), Crohn's disease (1 trial versus mesalazine, n=102), knee osteoarthritis (2 trials versus placebo and 1 trial versus valdecoxib, n=96) and collagenous colitis (1 trial versus placebo, n=31).

One study reported no significant difference between Boswellia and placebo in patients with rheumatoid arthritis (n=37).

Adverse effects were minor and judged as not causally related to the treatment.

Authors' conclusions

Boswellia serrata extracts appear to be effective in treating a range of conditions caused or maintained by inflammatory processes. However, the evidence is encouraging rather than convincing and further research is warranted.

CRD commentary

This review addressed a broad clinical question with partially specified inclusion criteria. The searches may not have addressed the specialist databases sufficiently. It was unclear to what extent unpublished work had been sought and, although some conference abstracts were searched, publication bias may have been present in this review. Only one reviewer performed study selection and data extraction, processes which are recommended to be performed by two reviewers to minimise reviewer error and bias. The quality was assessed by two reviewers and reported appropriately. The narrative analysis seems to have been appropriate, but there was no clear justification for not examining the apparently clinically homogeneous trials of B. serrata in knee osteoarthritis in more detail or using meta-analytic techniques. Overall this was a reasonably well conducted review, despite some limitations in the methods, and the author's conclusions are likely to be reliable.

Implications of the review for practice and research

The author did not state any implications for practice or research.

Funding

None.

Bibliographic details

Ernst E. Frankincense: systematic review. BMJ 2008; 337:a2813. [PMC free article: PMC2605614] [PubMed: 19091760]

Indexing Status

Subject indexing assigned by NLM

MeSH

Boswellia; Humans; Phytotherapy; Plant Extracts /therapeutic use; Randomized Controlled Trials as Topic

AccessionNumber

12008107697

Database entry date

31/03/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

Copyright © 2014 University of York.
Bookshelf ID: NBK75572

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