Anti-inflammatory activity of willow bark extract (Salix alba) and its effect on inflammation markers in the human body
DOI:
https://doi.org/10.63341/bmbr/2.2025.40Keywords:
pharmacology, ibuprofen, osteoarthritis, C-reactive protein, salicylatesAbstract
The study aimed to evaluate the anti-inflammatory efficacy and safety of Salix alba bark extract compared to ibuprofen in patients with knee osteoarthritis. A 12-week randomised controlled trial in Ukraine involved 120 patients diagnosed with stage II-III osteoarthritis, divided into two groups: the first received a standardised willow extract (240 mg of salicin per day), the second received ibuprofen (1,200 mg/day). Pain scores on a visual analogue scale decreased from 7.4 ± 1.2 to 3.1 ± 1.5 points (Δ= 4.3; p < 0.001) in the Salix alba group and from 7.6 ± 1.1 to 3.0 ± 1. 4 points (Δ= 4.6; p = 0.12)
in the ibuprofen group. Joint function, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, improved by 42% and 45%, respectively (p= 0.24). C-reactive protein levels decreased by 55% versus 60% (p= 0.18), interleukin-6 by 58% versus 60% (p = 0.29), and tumour necrosis factor-α by 50% versus 52% (p = 0.41). Side effects were reported in 10% of patients in the willow group versus 25% in the control group, mainly gastrointestinal in nature. A moderate correlation was found between blood salicin levels and pain reduction (r = 0.45; p < 0.001). The results proved that Salix alba extract has similar efficacy to ibuprofen, but with a lower risk of complications due to its multifunctional action (inhibition of cyclooxygenases, cytokine modulation, antioxidant effect). The data obtained justify the use of the extract as an alternative to synthetic anti-inflammatory drugs in clinical practice, especially for patients with chronic inflammatory diseases, where long-term use of non-steroidal anti-inflammatory drugs is accompanied by an increased
risk of side effects. The results of the study can be used by rheumatologists and therapists in clinical practice to prescribe Salix alba extract as a safe alternative to non-steroidal anti-inflammatory drugs for patients with osteoarthritis
Received: 16.12.2024 | Revised: 10.04.2025 | Accepted: 27.05.2025
References
Khusanboyev F. Study of the anti-inflammatory properties of a cream based on white willow bark. Kharkiv: National Pharmaceutical University; 2025. 51 P.
Mykhailyk D. Research on the selection of the optimal extractant and extraction regime of white willow bark. Kharkiv: National Pharmaceutical University; 2022. 61 P.
Maloshtan L, Artemova K, Shatalova O. Study of the analgesic and anti-inflammatory activity of dry extract from Sakhalin willow shoots. Pharm J. 2021;4:103–10. DOI: 10.32352/0367-3057.4.21.09/
Aleman RS, Marcia J, Duque-Soto C, Lozano-Sánchez J, Montero-Fernández I, Ruano JA, et al. Effect of microwave and ultrasound-assisted extraction on the phytochemical and in vitro biological properties of willow (Salix alba) bark aqueous and ethanolic extracts. Plants. 2023;12(13):2533. DOI: 10.3390/plants12132533
Nica IC, Mernea M, Stoian G, Dinischiotu A. Natural aspirin-like compounds from white willow (Salix alba) bark extract prevent structural changes of human hemoglobin during in vitro non-enzymatic glycation and fructation, preserving its peroxidase and esterase activity. Med Sci Forum. 2021;2(1):23. DOI: 10.3390/CAHD2020-08602
Abdalrahman MR, Sofi SA. The bark extraction of Salix Aegyptiaca L antibacterial activity. J Contemp Issues Bus Gov. 2021;27(3):169–71.
Lin CR, Tsai SHL, Wang C, Lee CL, Hung SW, Ting YT, et al. Willow bark (Salix spp.) used for pain relief in arthritis: A meta-analysis of randomized controlled trials. Life. 2023;13(10):2058. DOI: 10.3390/life13102058
Piątczak E, Dybowska M, Płuciennik E, Kośla K, Kolniak-Ostek J, Kalinowska-Lis U. Identification and accumulation of phenolic compounds in the leaves and bark of Salix alba (L.) and their biological potential. Biomolecules. 2020;10(10):1391. DOI: 10.3390/biom10101391
Tawfeek N, Mahmoud MF, Hamdan DI, Sobeh M, Farrag N, Wink M, et al. Phytochemistry, pharmacology and medicinal uses of plants of the genus Salix: An updated review. Front Pharmacol. 2021;12:593856. DOI: 10.3389/fphar.2021.593856
Andrei M, Tefaniu A, Ene N, Pintilie L, Radu N, Tomescu AJ, et al. Multiple natural approaches of Salix alba. Arch Microbiol Immunol. 2024;8:410–27. DOI: 10.26502/ami.936500188
Shara M, Stohs SJ. Efficacy and safety of white willow bark (Salix alba) extracts. Phytother Res. 2015;29(8):1112–6. DOI: 10.1002/ptr.5377
Nahrstedt A, Schmidt M, Jäggi R, Metz J, Khayyal MT. Willow bark extract: The contribution of polyphenols to the overall effect. Wien Med Wochenschr. 2007;157:348–51. DOI: 10.1007/s10354-007-0437-3
Kalia S, Bharti VK, Giri A, Malairaman U, Biswas A, Kumar B. Effect of Salix alba leaf extract on growth performance, antioxidant level and immune status of broiler chickens reared at high altitude cold desert. Biologia. 2021;76:3003–15. DOI: 10.1007/s11756-021-00795-w
Chrubasik S, Eisenberg E, Balan E, Weinberger T, Luzzati R, Conradt C. Treatment of low back pain exacerbations with willow bark extract: A randomized double-blind study. Am J Med. 2000;109(1):9–14. DOI: 10.1016/s0002-9343(00)00442-3
American College of Rheumatology. Criteria [Internet]. [cited 2024 December 2]. Available from: https://rheumatology.org/criteria
Huskisson EC. Measurement of pain. Lancet. 1974;304(7889):1127–31. DOI: 10.1016/S0140-6736(74)90884-8
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40.
MedWatch: The FDA safety information and adverse event reporting program [Internet]. [cited 2024 December 2]. Available from: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program
IBM. SPSS statistics [Internet]. [cited 2024 December 2]. Available from: https://www.ibm.com/products/spss-statistics
European Commission. Ethics and Data Protection [Internet]. 2021 July 5 [cited 2024 December 2]. Available from: https://ec.europa.eu/info/funding-tenders/opportunities/docs/2021-2027/horizon/guidance/ethics-and-data-protection_he_en.pdf
Gligorić EI, Igić R, Suvajdžić LD, Teofilović BD, Grujić-Letić NN. Salix eleagnos Scop. – a novel source of antioxidant and anti-inflammatory compounds: Biochemical screening and in silico approaches. S Afr J Bot. 2020;128:339–48. DOI: 10.1016/j.sajb.2019.11.018
Al-shattrawi HJ. Effect of willow bark extract on the activity of gram-negative intestinal bacteria: A review. Cent Asian J Med Nat Sci. 2025;6(2):659–78. DOI: 10.17605/cajmns.v6i2.2742
Maistro EL, Terrazzas PM, Sawaya ACHF, Rosa PCP, Perazzo FF, de Mascarenhas Gaivão ION. In vivo toxicogenic potential of Salix alba (Salicaceae) bark extract. J Toxicol Environ Health A. 2022;85(3):121–30. DOI: 10.1080/15287394.2021.1989351
Ojeda-Ramírez D, Rivero-Perez N, Ocampo-López J, Zaragoza-Bastida A, Sosa-Gutiérrez C, Peláez-Acero A. Salix babylonica a source of active compounds for the treatment of inflammatory diseases in animals. Abanico Vet. 2023;13:1–14. DOI:10.21929/abavet2023.9
Carpa R, Remizovschi A, Burtescu RF, Culda CA, Kryvtsova M, Hasynets Y, et al. Salicin content from Salix alba L. and Salix purpurea L. extracts and its antibacterial effects. Contrib Bot. 2022;57:133–42. DOI: 10.24193/contrib.bot.57.10
Faid S. Treatment effect of willow leaves on rheumatoid arthritis in chronic inflammatory disorders of rats. J Res Spec Educ. 2021;7(34):345–71. DOI: 10.21608/jedu.2021.57432.1196
Phillips HN, Sharpe KT, Endres MI, Heins BJ. Effects of oral white willow bark (Salix alba) and intravenous flunixin meglumine on prostaglandin E2 in healthy dairy calves. JDS Commun. 2022;3(1):49–54. doi: 10.3168/jdsc.2021-0138
Warmiński K, Stolarski MJ, Gil Ł, Krzyżaniak M. Willow bark and wood as a source of bioactive compounds and bioenergy feedstock. Ind Crops Prod. 2021;171:113976. DOI: 10.1016/j.indcrop.2021.113976
Tienaho J, Reshamwala D, Sarjala T, Kilpeläinen P, Liimatainen J, Dou J, et al. Salix spp. bark hot water extracts show antiviral, antibacterial, and antioxidant activities – the bioactive properties of 16 clones. Front Bioeng Biotechnol. 2021;9:797939. DOI: 10.3389/fbioe.2021.797939
Zheng L, Jacquier JC, Harbourne N. Preparation of polyphenol-rich herbal beverages from white willow (Salix alba) bark with potential Alzheimer’s disease inhibitory activity in silico. Beverages. 2024;10(3):75. DOI: 10.3390/beverages10030075
Reshamwala D, Shroff S, Liimatainen J, Tienaho J, Laajala M, Kilpeläinen P, et al. Willow (Salix spp.) bark hot water extracts inhibit both enveloped and non-enveloped viruses: Study on its anti-coronavirus and anti-enterovirus activities. Front Microbiol. 2023;14:1249794. DOI: 10.3389/fmicb.2023.1249794
Gligorić EI, Igić R, Teofilović B, Grujić-Letić N. Phytochemical screening of ultrasonic extracts of Salix species and molecular docking study of Salix-derived bioactive compounds targeting pro-inflammatory cytokines. Int J Mol Sci. 2023;24(14):11848. DOI: 10.3390/ijms241411848
Sharma I, Manral P, Joshi N. Formulation & evaluation of anti-inflammatory effervescent tablet using white willow bark. In: Proceedings of The 3rd international conference on optimization techniques in the field of engineering. Namakkal: K.S.R. College of Engineering; 2024. DOI: 10.2139/ssrn.5089006
Neagu M, Luntraru C, Bîra A, Tomescu J, Ionescu N, Stan R. Bioactive phenolic compounds from white willow (Salix alba) bark, leaves and branches. UPB Sci Bull B. 2021;83(3):41–50.
Le NPK, Herz C, Gomes JVD, Förster N, Antoniadou K, Mittermeier-Kleßinger VK, et al. Comparative anti-inflammatory effects of Salix cortex extracts and acetylsalicylic acid in SARS-CoV-2 peptide and LPS-activated human in vitro systems. Int J Mol Sci. 2021;22(13):6766. DOI: 10.3390/ijms22136766
Venger IK, Kostiv SYa, Selskyy BP, Orlov MP, Tsiupryk NI. Intraoperative state of the hemocoagulation system in patients with open and endovascular revascularization of infraingual arterial segment in the presence of stenotic-occlusive process of tibial arteries. Int J Med Med Res. 2022;8(2):38–43. DOI:10.11603/ijmmr.2413-6077.2022.2.13197
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Bulletin of Medical and Biological Research

This work is licensed under a Creative Commons Attribution 4.0 International License.











