Abstract

A META-ANALYSIS OF THE RANDOMIZED CONTROLLED TRIALS OF INDIVIDUALIZED HOMEOPATHY IN RHEUMATOID ARTHRITIS

*Subhranil Saha¹, Munmun Koley¹, Robert Medhurst²

ABSTRACT

Objective: Homeopathy seems scientifically implausible and is one of the most controversial forms of complementary and alternative medicine (CAM) therapies. This review aims to summarize and compare treatment effects of homeopathy with control in rheumatoid arthritis (RA). Methods: Relevant studies were identified by a comprehensive literature search in electronic databases, reference list of relevant papers, and contacts with experts. Clinical trials comparing individualized homeopathic treatment with control were eligible. Information on patients, interventions and comparators, outcomes, and study design was extracted in a standardized manner and quality was assessed using Jadad scoring and Cochrane bias minimization criteria. Trials providing sufficient data were pooled in a quantitative metaanalysis forest plot model. Odds ratio above 1 indicated benefit. Bias effects were examined using funnel plot. Results: A total of eleven controlled clinical trials were identified; six used ‘combination formulae’ and were excluded; the other five used individualized homeopathy, and were included in the analysis. Methodological quality of the trials was variable. Methodologically the highest quality trials reported the most negative results for homeopathy. The combined odds ratio for the five studies entered into the meta-analysis was 1.259 (95% confidence interval 0.560 to 2.829; p=0.577 two-tailed) in the random effect forest plot model; showing a positive trend, yet no statistically significant difference in favor of homeopathy. Heterogeneity was substantial amounting to Q=11.467, I2=65.118, and τ2=0.544. Publication bias, as evidenced by outlying of one study in the 95% CI of the funnel plot, occurred in the analysis, but was non-significant (negative Egger’s test of intercept, p=0.26435; and nonsignificant Begg’s rank correlation test, p=0.46243). Conclusion: The results showed that homeopathy had an advantage over control in treatment of RA; however, statistical significance could not be established. The evidence was not convincing because of methodological inconsistencies which prohibited the formation of a definite conclusion. Further replications are warranted provided the trials are methodologically consistent, rigorous and systematic. Systematic review registration number: CRD42013004747, June 3, 2013 [PROSPERO]

Keywords: Homeopathy, clinical trials, rheumatoid arthritis, systematic review, metaanalysis.