Osteoarthritis is the most common form of joint disease and the leading cause of pain and disability in the elderly. S-Adenosylmethionine ( SAMe; Samyr ) may be a viable treatment option but the evidence about its effectiveness and safety is equivocal.

Researchers have compared S-Adenosylmethionine with placebo or no specific intervention in terms of effects on pain and function and safety outcomes in patients with knee or hip osteoarthritis.

Four trials with 656 patients were included in the systematic review, all compared SAMe with placebo.

The methodological quality and the quality of reporting were poor.

For pain, the analysis indicated a small standardised mean differences ( SMD ) of -0.17, corresponding to a difference in pain scores between SAMe and placebo of 0.4 cm on a 10 cm VAS, with no between trial heterogeneity( I2 = 0 ).

For function, the analysis suggested a SMD of 0.02 with a moderate degree of between-trial heterogeneity ( I2 = 54% ).

The meta-analyses of the number of patients experiencing any adverse event, and withdrawals or drop-outs due to adverse events, resulted in relative risks of 1.27 and 0.94, respectively, but confidence intervals were wide and tests for overall effect were not significant.
No trial provided information concerning the occurrence of serious adverse events.

In conclusion, this systematic review is inconclusive, hampered by the inclusion of mainly small trials of questionable quality. The effects of SAMe on both pain and function may be potentially clinically relevant and, although effects are expected to be small, deserve further clinical evaluation in adequately sized randomised, parallel-group trials in patients with knee or hip osteoarthritis. Meanwhile, routine use of SAMe should not be advised.

Rutjes AW et al, Cochrane Database Syst Rev 2009;(4):CD007321

XagenaMedicine2009


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