HHS: SAM-e Studies Promising, More Research Needed

ROCKVILLE, Md.--S-adenosyl-L-methionine (SAM-e) may be usefulfor depression, osteoarthritis and liver disease, according to an evidencereport released by the Agency for Healthcare Research and Quality (AHRQ), an armof the Department of Health and Human Services (HHS). The AHRQ meta-analysisincluded 99 articles representing 102 individual studies, which were broken downinto 47 depression studies, 14 osteoarthritis studies and 41 liver diseasestudies.

A panel of technical experts was established to advise the researchersthroughout their study of SAM-e. In terms of depression, the researchersconcluded SAM-e was statistically superior to placebo, and it performedsimilarly to conventional antidepressant treatment. As for its ability todecrease osteoarthritis pain, SAM-e performed more effectively than placebo andsimilarly to non-steroidal, anti-inflammatory medication. For liver disease,researchers studied SAM-e's efficacy for reducing intrahepatic cholestasis ofpregnancy and intrahepatic cholestasis associated with liver disease. Inpregnancy, this condition--which is characterized by a failure of bile flowthrough the liver and is manifested in itchy hands and feet and jaundice--cancause premature delivery or fetal death. In the event of intrahepaticcholestasis not associated with pregnancy, the condition is a relatively commoncomplication of a number of acute and chronic liver diseases. SAM-e was found todecrease serum bilirubin levels (a marker of cholestasis) compared to placebo,although traditional therapy was found to be superior to SAM-e in thispopulation. For intrahepatic cholestasis caused by liver disease, SAM-e patientswere twice as likely to demonstrate a reduction in pruritus (jaundice) comparedto placebo. Researchers noted there were too few studies comparing SAM-e topharmaceutical treatment in this population to allow for a pooled analysis.

AHRQ concluded its summary by noting existing SAM-e research indicates anumber of promising areas for future research with SAM-e. For example, studieselucidating the pharmacology of SAM-e and clinical trials are needed, and abetter understanding of the risk-to-benefit ratio of SAM-e compared toconventional therapy--especially for depression and osteoarthritis--is veryimportant, according to AHRQ. In addition, the summary stated dose-escalationstudies have not been performed with oral SAM-e for depression, osteoarthritisor liver disease. Any future trials investigating this point would require largenumbers of patients with homogeneous diagnoses and focus on significant clinicaloutcomes, according to the AHRQ (www.ahcpr.gov).