The six-month long clinical trial is said to be the first-of-its-kind study to assess the therapeutic efficacy of tocotrienol-rich fraction (TRF) in reducing disease activity.
Derived from palm oil, TRF contains alpha-, beta-, gamma, and gamma-T3 forms of vitamin E and has anti-inflammatory properties.
Rheumatoid arthritis, on the other hand, is an autoimmune inflammatory illness that causes severe joint pain.
This happens when an individual’s immune system mistakenly targets healthy joint cells, causing swelling and inflammation.
Findings of the study funded by the Malaysian Palm Oil Board (MPOB) were published in the European Journal of Nutrition.
Conducted by MPOB in collaboration with Sultan Idris Shah Hospital, the study involved 50 patients between 20 to 70 years old, and had mild rheumatoid arthritis with Disease Activity Score-28 (DAS 28) of 3.2 to 5.1.
The participants were randomised to take either 1) 400mg of TRF daily or 2) matching placebo capsules for six months and nine months post-intervention.
The TRF, commercially available as Tocovid™ Suprabio™, was supplied by Hovid Sdn. Bhd. It contains 70% of tocotrienol and 30% of tocopherol.
Both groups also received regular doses of disease-modifying anti-rheumatic drugs (DMARDs) throughout the study.
Effects of TRF were assessed by measuring changes in DAS 28 scores.
DAS 28 measures disease activity such as joint tenderness and swelling. A score of below 3.2 is considered negligible, mild for scores of 3.2 to 5.1 and severe for scores over 5.1.
Blood samples were also collected for biochemical markers analysis.
A key finding of the study was a significant reduction in the DAS 28 scores in the group taking TRF as compared to the placebo.
At baseline, the DAS28 score for the TRF group was 4.373 ± 0.145, which was down to about 3.0 by the end of the intervention.
For the placebo group, the DAS28 score was 4.223 ± 0.147 at baseline and it also saw a decrease to about 3.5 by the end of the intervention.
A reduction of 0.6 points in the DAS 28 score is considered a moderate improvement, while a reduction greater than 1.2 points is considered a significant improvement.
A score of below 2.6 typically indicates disease remission.
Although the placebo group also saw a reduction in DAS 28 score, the researchers said this could be due to the presence of residual vitamin E in the palm olein used as the placebo.
“Crude palm oil is a natural source of vitamin E, particularly tocotrienols, which possess antioxidant and anti-inflammatory properties. While the refining process of palm olein can significantly reduce vitamin E content, it is possible that trace amounts may remain in the final product.
“This residual vitamin E content in the placebo may have contributed to a modest reduction in some disease activity markers in the placebo group.
“However, the magnitude of these reductions was significantly less pronounced compared to the improvements observed in the TRF group, which received a significantly higher dose of tocotrienols,” the researchers explained.
Less pain and stiffness
There were also significant reduction in discomfort, such as morning stiffness and a decrease in the number of painful and swollen joints in the TRF group.
This was reflected in the significant decrease in their tender disease activity score (tDAS) and swollen disease activity score (sDAS) throughout the six-month intervention.
There was also a significant reduction in their visual analogue scale (VAS) - which is a pain rating scale.
In contrast, the placebo group only reported a significant reduction in VAS but not in other areas such as tDAS and sDAS.
In fact, improvements seen in some participants from the TRF group have led to a reduction in their reliance on non-steroidal anti-inflammatory drugs (NSAIDs) to manage their symptoms.
“To our knowledge, this is the first study to undertake such as comprehensive analysis. In conclusion, the RCT demonstrates that TRF effectively improves pain and joint function in RA patients, with no increased risk of adverse effects,” said the researchers.
Source: European Journal of Nutrition
Reduction of disease activity in rheumatoid arthritis by tocotrienol‑rich fraction supplementation: a randomized, double‑blind, placebo‑controlled trial
https://doi.org/10.1007/s00394-025-03742-6
Authors: Zainal et al
