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Review
. 2014 Feb 20;2014(2):CD000530.
doi: 10.1002/14651858.CD000530.pub3.

Echinacea for preventing and treating the common cold

Marlies Karsch-Völk  1 , Bruce Barrett, David Kiefer, Rudolf Bauer, Karin Ardjomand-Woelkart, Klaus Linde
Affiliations
Review

Echinacea for preventing and treating the common cold

Marlies Karsch-Völk et al. Cochrane Database Syst Rev. .

Abstract

Background: Echinacea plant preparations (family Asteraceae) are widely used in Europe and North America for common colds. Most consumers and physicians are not aware that products available under the term Echinacea differ appreciably in their composition, mainly due to the use of variable plant material, extraction methods and the addition of other components.

Objectives: To assess whether there is evidence that Echinacea preparations are effective and safe compared to placebo in the prevention and treatment of the common cold.

Search methods: We searched CENTRAL 2013, Issue 5, MEDLINE (1946 to May week 5, 2013), EMBASE (1991 to June 2013), CINAHL (1981 to June 2013), AMED (1985 to February 2012), LILACS (1981 to June 2013), Web of Science (1955 to June 2013), CAMBASE (no time limits), the Centre for Complementary Medicine Research (1988 to September 2007), WHO ICTRP and clinicaltrials.gov (last searched 5 June 2013), screened references and asked experts in the field about published and unpublished studies.

Selection criteria: Randomized controlled trials (RCTs) comparing mono-preparations of Echinacea with placebo.

Data collection and analysis: At least two review authors independently assessed eligibility and trial quality and extracted data. The primary efficacy outcome was the number of individuals with at least one cold in prevention trials and the duration of colds in treatment trials. For all included trials the primary safety and acceptability outcome was the number of participants dropping out due to adverse events. We assessed trial quality using the Cochrane 'Risk of bias' tool.

Main results: Twenty-four double-blind trials with 4631 participants including a total of 33 comparisons of Echinacea preparations and placebo met the inclusion criteria. A variety of different Echinacea preparations based on different species and parts of plant were used. Evidence from seven trials was available for preparations based on the aerial parts of Echinacea purpurea. Ten trials were considered to have a low risk of bias, six to have an unclear risk of bias and eight to have a high risk of bias. Ten trials with 13 comparisons investigated prevention and 15 trials with 20 comparisons investigated treatment of colds (one trial addressed both prevention and treatment).Due to the strong clinical heterogeneity of the studies we refrained from pooling for the main analysis. None of the 12 prevention comparisons reporting the number of patients with at least one cold episode found a statistically significant difference. However a post hoc pooling of their results, suggests a relative risk reduction of 10% to 20%. Of the seven treatment trials reporting data on the duration of colds, only one showed a significant effect of Echinacea over placebo. The number of patients dropping out or reporting adverse effects did not differ significantly between treatment and control groups in prevention and treatment trials. However, in prevention trials there was a trend towards a larger number of patients dropping out due to adverse events in the treatment groups.

Authors' conclusions: Echinacea products have not here been shown to provide benefits for treating colds, although, it is possible there is a weak benefit from some Echinacea products: the results of individual prophylaxis trials consistently show positive (if non-significant) trends, although potential effects are of questionable clinical relevance.

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Conflict of interest statement

Klaus Linde was involved in one, Karin Ardjomand‐Woelkart in one, Bruce Barrett in two and Rudolf Bauer in four of the studies included in this review. Marlies Karsch‐Völk and David Kiefer have no conflict of interest. Authors did not carry out data extraction or quality assessment of studies they were involved in.

Figures

1
1
study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Echinacea versus placebo to prevent common cold, outcome: 1.1 Number of participants with at least 1 cold episode.
5
5
Forest plot of comparison: 2 Echinacea versus placebo to treat patients with common cold, outcome: 2.1 Duration: mean difference.
6
6
Forest plot of comparison: 1 Echinacea versus placebo to prevent common cold, outcome: 1.5 Number of patients dropping out due to adverse effects.
1.1
1.1. Analysis
Comparison 1 Echinacea versus placebo to prevent common cold, Outcome 1 Number of participants with at least 1 cold episode.
1.2
1.2. Analysis
Comparison 1 Echinacea versus placebo to prevent common cold, Outcome 2 Number of participants with more than 1 cold.
1.3
1.3. Analysis
Comparison 1 Echinacea versus placebo to prevent common cold, Outcome 3 Duration: mean difference.
1.4
1.4. Analysis
Comparison 1 Echinacea versus placebo to prevent common cold, Outcome 4 Total severity score.
1.5
1.5. Analysis
Comparison 1 Echinacea versus placebo to prevent common cold, Outcome 5 Number of patients dropping out due to adverse effects.
1.6
1.6. Analysis
Comparison 1 Echinacea versus placebo to prevent common cold, Outcome 6 Number of patients dropping out.
1.7
1.7. Analysis
Comparison 1 Echinacea versus placebo to prevent common cold, Outcome 7 Number of patients reporting adverse effects.
2.1
2.1. Analysis
Comparison 2 Echinacea versus placebo to treat patients with common cold, Outcome 1 Duration: mean difference.
2.2
2.2. Analysis
Comparison 2 Echinacea versus placebo to treat patients with common cold, Outcome 2 Duration (inverse variance).
2.3
2.3. Analysis
Comparison 2 Echinacea versus placebo to treat patients with common cold, Outcome 3 Total severity and duration measures (for example, area under the curve).
2.4
2.4. Analysis
Comparison 2 Echinacea versus placebo to treat patients with common cold, Outcome 4 Sum score after 2 to 4 days.
2.5
2.5. Analysis
Comparison 2 Echinacea versus placebo to treat patients with common cold, Outcome 5 Sum scores after 5 to 10 days.
2.6
2.6. Analysis
Comparison 2 Echinacea versus placebo to treat patients with common cold, Outcome 6 Early treatment of prodromi: patients developing a 'full' cold.
2.7
2.7. Analysis
Comparison 2 Echinacea versus placebo to treat patients with common cold, Outcome 7 Number of patients dropping out due to adverse effects.
2.8
2.8. Analysis
Comparison 2 Echinacea versus placebo to treat patients with common cold, Outcome 8 Number of patients dropping out.
2.9
2.9. Analysis
Comparison 2 Echinacea versus placebo to treat patients with common cold, Outcome 9 Number of patients reporting adverse effects.
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References to other published versions of this review

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