October 4, 2002
ROCKVILLE, Md.--S-adenosyl-L-methionine (SAM-e) may be useful for depression, osteoarthritis and liver disease, according to an evidence report released by the Agency for Healthcare Research and Quality (AHRQ), an arm of the Department of Health and Human Services (HHS). The AHRQ meta-analysis included 99 articles representing 102 individual studies, which were broken down into 47 depression studies, 14 osteoarthritis studies and 41 liver disease studies.
A panel of technical experts was established to advise the researchers throughout their study of SAM-e. In terms of depression, the researchers concluded SAM-e was statistically superior to placebo, and it performed similarly to conventional antidepressant treatment. As for its ability to decrease osteoarthritis pain, SAM-e performed more effectively than placebo and similarly to non-steroidal, anti-inflammatory medication. For liver disease, researchers studied SAM-e's efficacy for reducing intrahepatic cholestasis of pregnancy and intrahepatic cholestasis associated with liver disease. In pregnancy, this condition--which is characterized by a failure of bile flow through the liver and is manifested in itchy hands and feet and jaundice--can cause premature delivery or fetal death. In the event of intrahepatic cholestasis not associated with pregnancy, the condition is a relatively common complication of a number of acute and chronic liver diseases. SAM-e was found to decrease serum bilirubin levels (a marker of cholestasis) compared to placebo, although traditional therapy was found to be superior to SAM-e in this population. For intrahepatic cholestasis caused by liver disease, SAM-e patients were twice as likely to demonstrate a reduction in pruritus (jaundice) compared to placebo. Researchers noted there were too few studies comparing SAM-e to pharmaceutical treatment in this population to allow for a pooled analysis.
AHRQ concluded its summary by noting existing SAM-e research indicates a number of promising areas for future research with SAM-e. For example, studies elucidating the pharmacology of SAM-e and clinical trials are needed, and a better understanding of the risk-to-benefit ratio of SAM-e compared to conventional therapy--especially for depression and osteoarthritis--is very important, according to AHRQ. In addition, the summary stated dose-escalation studies have not been performed with oral SAM-e for depression, osteoarthritis or liver disease. Any future trials investigating this point would require large numbers of patients with homogeneous diagnoses and focus on significant clinical outcomes, according to the AHRQ (www.ahcpr.gov).
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