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Echinacea for treating the common cold: a randomized trial.

  • 2010-12-21
  • Annals of internal medicine 153(12)
    • Bruce Barrett
    • Roger Brown
    • Dave Rakel
    • Marlon Mundt
    • Kerry Bone
    • Shari Barlow
    • Tola Ewers

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 719
Population
719 patients, aged 12 to 80 years, with new-onset common cold
Methods
Randomized, controlled trial. Patients were assigned to 1 of 4 parallel groups: no pills, placebo pills (blinded), echinacea pills (blinded), or echinacea pills (unblinded, open-label). Echinacea groups received the equivalent of 10.2 g of dried echinacea root during the first 24 hours and 5.1 g during each of the next 4 days. Indistinguishable placebo tablets contained only inert ingredients.
Blinding
Double-blind
Duration
the first 24 hours and 5.1 g during each of the next 4 days
Funding
Independent
  • Large Human Trial
  • Rigorous Journal

Background

Echinacea is widely used to treat the common cold.

Objective

To assess the potential benefits of echinacea as a treatment of common cold.

Design

Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00065715)

Setting

Dane County, Wisconsin.

Patients

719 patients, aged 12 to 80 years, with new-onset common cold.

Intervention

Patients were assigned to 1 of 4 parallel groups: no pills, placebo pills (blinded), echinacea pills (blinded), or echinacea pills (unblinded, open-label). Echinacea groups received the equivalent of 10.2 g of dried echinacea root during the first 24 hours and 5.1 g during each of the next 4 days. Indistinguishable placebo tablets contained only inert ingredients.

Measurements

The primary outcome was the area under the curve for global severity, with severity assessed twice daily by self-report using the Wisconsin Upper Respiratory Symptom Survey, short version. Secondary outcomes included interleukin-8 levels and neutrophil counts from nasal wash, assessed at intake and 2 days later.

Results

Of the 719 patients enrolled, 713 completed the protocol. Mean age was 33.7 years, 64% were female, and 88% were white. Mean global severity was 236 and 258 for the blinded and unblinded echinacea groups, respectively; 264 for the blinded placebo group; and 286 for the no-pill group. A comparison of the 2 blinded groups showed a 28-point trend (95% CI, -69 to 13 points) toward benefit for echinacea (P = 0.089). Mean illness duration in the blinded and unblinded echinacea groups was 6.34 and 6.76 days, respectively, compared with 6.87 days in the blinded placebo group and 7.03 days in the no-pill group. A comparison of the blinded groups showed a nonsignificant 0.53-day (CI, -1.25 to 0.19 days) benefit (P = 0.075). Median change in interleukin-8 levels and neutrophil counts were also not statistically significant (30 ng/L and 1 cell/high-power field [hpf] in the no-pill group, 39 ng/L and 1 cell/hpf in the blinded placebo group, 58 ng/L and 2 cells/hpf in the blinded echinacea group, and 70 ng/L and 1 cell/hpf in the open-label echinacea group).

Limitation

Higher-than-expected variability limited power to detect small benefits.

Conclusion

Illness duration and severity were not statistically significant with echinacea compared with placebo. These results do not support the ability of this dose of the echinacea formulation to substantively change the course of the common cold.

Primary funding source

National Center for Complementary and Alternative Medicine, National Institutes of Health.

Research Insights

  • Echinacea→Increased Interleukin 8 Levels

    Median change in interleukin-8 levels and neutrophil counts were also not statistically significant (30 ng/L and 1 cell/high-power field [hpf] in the no-pill group, 39 ng/L and 1 cell/hpf in the blinded placebo group, 58 ng/L and 2 cells/hpf in the blinded echinacea group, and 70 ng/L and 1 cell/hpf in the open-label echinacea group).

    Effect
    Neutral
    Effect size
    Small
    Dose
    equivalent of 10.2 g of dried echinacea root during the first 24 hours and 5.1 g during each of the next 4 days
  • Echinacea→Reduced Cold Duration

    Mean illness duration in the blinded and unblinded echinacea groups was 6.34 and 6.76 days, respectively, compared with 6.87 days in the blinded placebo group and 7.03 days in the no-pill group. A comparison of the blinded groups showed a nonsignificant 0.53-day (CI, -1.25 to 0.19 days) benefit (P = 0.075).

    Effect
    Neutral
    Effect size
    Small
    Dose
    equivalent of 10.2 g of dried echinacea root during the first 24 hours and 5.1 g during each of the next 4 days
  • Echinacea→Reduced Cold Severity

    Mean global severity was 236 and 258 for the blinded and unblinded echinacea groups, respectively; 264 for the blinded placebo group; and 286 for the no-pill group. A comparison of the 2 blinded groups showed a 28-point trend (95% CI, -69 to 13 points) toward benefit for echinacea (P = 0.089).

    Effect
    Neutral
    Effect size
    Small
    Dose
    equivalent of 10.2 g of dried echinacea root during the first 24 hours and 5.1 g during each of the next 4 days
  • Echinacea→Reduced Neutrophil Count

    Median change in interleukin-8 levels and neutrophil counts were also not statistically significant (30 ng/L and 1 cell/high-power field [hpf] in the no-pill group, 39 ng/L and 1 cell/hpf in the blinded placebo group, 58 ng/L and 2 cells/hpf in the blinded echinacea group, and 70 ng/L and 1 cell/hpf in the open-label echinacea group).

    Effect
    Neutral
    Effect size
    Small
    Dose
    equivalent of 10.2 g of dried echinacea root during the first 24 hours and 5.1 g during each of the next 4 days
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