The efficacy of herbal medicines used in the management of sickle cell disease: a systematic review of two randomised control studies

Background: Over 300,000 babies are born with the severe form of sickle cell disease (SCD) worldwide, with most occurring in low-and middle-income countries. Although the pathophysiology of this disease is now better understood, there are still few conventional pharmacological treatments available, with these medicines having adverse effects that affect compliance. Various herbal remedies have been employed since the discovery of SCD to minimise unpleasant sickling events. Additionally, an increasing number of patients have turned to complementary and alternative medicines (CAM) and naturopathic substances in managing excruciating episodes. Objective: This mini-systematic review assessed the efficacy of medicinal plants used in the management of SCD. Method: A web-based literature search was conducted in PubMed, Scopus (Elsevier), Cochrane Library and CINAHL Complete (Ebsco) to obtain randomised controlled studies. Two hundred and five articles were retrieved, of which only two were included in the review. Results and Concludions: This study found that two phytomedicines, Niprisan® and Ciklavit®, significantly reduced severe pain in patients. The mean frequency of times patients reported severe pains during the 6-month trials was 7.9 for the Niprisan® group and 21.1 for the placebo. After cross-over in the second 6 months, the placebo was 6.9, and Niprisan® was 4.1. Side effects experienced included non-itching macular rashes and headaches. Ciklavit® also reduced painful crises from 207 to 191 with mild side effects, including abdominal distention and tiredness. Niprisan® did not significantly change liver enzyme activity, cause significant differences in jaundice and serum bilirubin, or cause acute liver or renal damage. A significant number of medicinal plants have been documented as folklorically used in managing SCD, its associated pain, and anaemia. These will need in-depth investigations for further advancements. This study highlights the potential benefits of using phytomedicines for the management of SCD.