SUMMARY OF FINDINGS FOR THE MAIN COMPARISON [Explanation]

Curcumin versus placebo for maintenance of remission in ulcerative colitis
Patient or population: Maintenance of remission in ulcerative colitis
Settings: Tertiary care centres in a high income country
Intervention: Curcumin versus placebo1
Outcomes	Illustrative comparative risks* (95% CI)			Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk10	Corresponding risk
	Control	Curcumin placebo	versus
Relapse at 6 months Clinical Disease Activty Index more than 42 Follow-up: 6 months	182 per 1000	44 per 1000 (9 to 198)		RR 0.24 (0.05 to 1.09)	89 (1 study)	⊕⊕○○ low3,4,5,6,7
Relapse at 12 months Clinical Disease Activty Index more than 42 Follow-up: 12 months	318 per 1000	223 per 1000 (111 to 445)		RR 0.7 (0.35 to 1.4)	89 (1 study)	⊕⊕○○ low3,4,6,7,7
Clinical Activity Index at 6 months Clinical Disease Activty Index 2. Scale from: 0 to 12. Follow-up: 6 months	The mean clinical activ- ity index at 6 months in the control groups was 2. 2 points	The mean Clinical Activity Index at 6 months in the intervention groups was 1.2 lower (2.14 to 0.26 lower)			82 (1 study)	⊕⊕○○ low3,4,6,7
Endoscopic Index at 6 months Endoscopic Index9. Scale from: 1 to 4. Follow-up: 6 months	The mean endoscopic in- dex at 6 months in the control groups was 1.6 points	The mean Endoscopic In- dex at 6 months in the in- tervention groups was 0.8 lower (1.33 to 0.27 lower)			82 (1 study)	⊕⊕○○ low3,4,6,7
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

¹Both arms received standard care and mesalamine or sulfasalazine

²Scores range from 0 to 12 (high scores reflect more severe disease)

³No study limitations: Central randomization and allocation concealed; investigators, outcome assessors and participants were blinded; analysis was by intention to treat; no overt reporting biases; no conflicts of interest

⁴No serious indirectness: This trial included only adults (who constitute about 95% of those with ulcerative colitis). This is a validated, clinically relevant outcome measure. Not downgraded

⁵Serious imprecision: There are relatively few events and wide confidence intervals around the estimate of effect that suggests appreciable benefit with curcumin as well as non-appreciable benefit with placebo. Downgraded by 1

⁶Publication Bias: Unlikely as the search was comprehensive

⁷Very serious imprecision: There are relatively few events and wide confidence intervals around the estimate of effect that suggests appreciable benefit with curcumin as well as with placebo and no statistically significance between the interventions. Downgraded by 2

⁸Serious imprecision: There are relatively few events and wide confidence intervals (CI) around the estimate of effect with the lower limit of the CI crossing 0.5. Downgraded by 1

⁹Scores assess healing of ulcers on sigmoidoscopy; range 1 to 4, with high scores indicating severe disease activity

¹⁰The assumed risk is the risk in the control group