Re: Methionine supplement (SAMe) equivalent to celecoxib in OA

[Guest guest]

,

Of all the supplements I¹ve taken, I¹ve never tried SAMe, but after reading

this and many

other articles, I am definitely going to try it. I don¹t want to take Vioxx

anymore after

reading one article to many, about the cardiac implications.

a

> Rheumawire

> Apr 21, 2004

>

> Methionine supplement equivalent to celecoxib in OA

>

> Orange, CA - A popular dietary supplement consisting of

> S-adenosylmethionine (SAMe) was found to be as effective as celecoxib

> (Celebrex®, Pfizer) in the management of symptoms of knee osteoarthritis

> (OA) in a study that followed 56 patients for 16 weeks.

>

> Although it had a slower onset of action, with significantly less pain

> relief than celecoxib in the first month of treatment, by the second

> month the 2 compounds were " clinically equivalent, " say the researchers,

> Dr Wadie Najm and colleagues (University of California, Irvine). The

> study is published online in BMC Musculoskeletal Disorders [1].

>

> The supplement is " helpful for the management of pain in osteoarthritis

> and demonstrates similar effectiveness as a currently accepted COX-2

> inhibitor, " they conclude.

>

> First discovered in Italy in 1952, SAMe has been used in Europe for some

> time, often as a prescription product, but it has also become a popular

> dietary supplement in the US. SAMe is reported to be effective in the

> management of depression, liver disease, and arthritis. In 2002, the US

> Agency for Healthcare Research and Quality (part of the Department of

> Health and Human Services) reviewed the evidence for these claims. For

> osteoarthritis, on the basis of 13 clinical trials, it concluded that

> SAMe was better than placebo and not different from nonsteroidal

> anti-inflammatory drugs (NSAIDs) at relieving pain [2].

>

> " SAMe is an important physiologic compound that is distributed

> throughout the body tissues and fluids, " Najm et al comment. It acts as

> a methyl group donor and plays an essential role in many biochemical

> reactions involving enzymatic transmethylation, eg, in the biosynthesis

> of phospholipids essential for the integrity of cell membranes.

> Nevertheless, despite this understanding of its role in the body, its

> mechanism of action in disease is unclear, the authors comment. In OA,

> there is evidence that it may play a role in reducing inflammation,

> increasing proteoglycan synthesis, or by having an analgesic effect,

> they add.

>

> Although it is now used orally, SAMe was in the past administered

> intravenously because of stability problems, which do not appear to have

> been altogether solved. For instance, in this current trial, when about

> 75% completed, a routine quality check of a random sample of the study

> medications indicated that SAMe had lost approximately 51% of its

> potency, and the study was delayed until a new batch of SAMe could be

> obtained.

>

> The study participants were randomly assigned to 1 of 2 sequences,

> receiving either SAMe 600 mg bid for 8 weeks, followed by a 1-week

> washout period, and then celecoxib 100 mg bid for 8 weeks, or the other

> way around.

>

> Pain was assessed on 2 visual analog scales: patients were asked to rate

> the pain they felt that day and also the pain they had felt over the

> past month.

>

> After 1 month, celecoxib showed significantly more reduction in pain

> than SAMe (p=0.024), but after the second month of treatment, there was

> no significant difference between the 2 medications (p<0.01), and both

> groups were significantly improved from baseline.

>

> The patients who initially took celecoxib and then the supplement were

> " noticeably but not significantly worse " than the group that shifted

> from the supplement to celecoxib after the first month of treatment, the

> authors note, but there were no apparent differences at the end of the

> second month.

>

> Both compounds showed a notable improvement from baseline on most

> functional health measures (including overall health, physical fitness,

> emotional well-being), with no significant differences between the 2.

> Isometric joint-function tests appeared to be steadily improving over

> the entire study period regardless of treatment, the authors write. Both

> groups showed significant improvements in tenderness in the knee,

> swelling in the knee, pain during walking, and in pain frequency.

>

> The most common adverse effects were gastrointestinal disorders

> (reported by 4 patients taking SAMe and 6 taking celecoxib), anxiety (5

> vs 4), and dyspepsia (1 vs 3); none of these differences was

> significant. One patient terminated the study due to headache 3 days

> into the SAMe phase, but this patient had a well-known history of such

> headaches before enrolling in the study, the researchers comment.

>

> " Our results indicate that SAMe is equivalent in almost all measures to

> COX-2 inhibitors (celecoxib) in relieving pain and improving function in

> subjects with osteoarthritis of the knee, " Najm et al conclude.

>

> " It is clear from our results that SAMe has a slower onset of action,

> requiring almost 1 month of treatment prior to achieving similar effect

> to celecoxib, " the researchers continue. In this, the COX-2 inhibitors

> and other NSAIDs have " a definite advantage during the first month of

> treatment, " they comment.

>

> However, after the second month of treatment, the pain-relieving effect

> was equivalent for both drugs, and it is interesting to note that, while

> the pain relief of celecoxib was constant throughout the study, the

> effect of SAMe continued to increase with time, the authors comment.

> " This raises the question of whether the effect of SAMe would have

> continued to improve had the study been for a longer period of time. "

>

> Also, the data suggest that the pain relief with SAMe persisted even

> after the medication was discontinued, they observe. " In this study, we

> noted that subjects who changed from SAMe to celecoxib had an initial

> decline in their pain level. " This initial dip beyond the baseline pain

> relief obtained by celecoxib alone, while not significant, hints at a

> possible persistent effect of SAMe for 1 month beyond discontinuation of

> the medication, they say.

>

> " This is reminiscent of reports on the pain-relieving effect observed

> with glucosamine sulfate, " they comment. If this result could be

> reproduced in future large studies, it may be possible to use SAMe as a

> pulsed therapy for the management of pain in OA, after an initial period

> to establish a steady level.

>

> Further studies are needed, as there are many questions left unanswered

> about this supplement, Najm et al conclude. As well as establishing

> optimal dose and mechanism of action, it would be worth exploring

> whether the combination of SAMe with a COX-2 inhibitor is more effective

> than either alone in the management of osteoarthritis.

>

> Zosia Chustecka

>

> Sources

>

> 1. Najm WI, Reinsch S, Hoehler F, et al. S-adenosyl methionine (SAMe)

> versus celecoxib for the treatment of osteoarthritis symptoms: a

> double-blind cross-over trial. BMC Musculoskelet Disord 2004. Available

> at: http://www.biomedcentral.com/1471-2474/5/6.

>

> 2. Evidence Report/Technology Assessment: Number 64.

> S-Adenosylmethionine for treatment of depression, osteoarthritis and

> liver disease. Agency for Healthcare Research and Quality [AHRQ

> Publication No. 02-E033]. August 2002. Available at:

> http://www.ahrq.gov/clinic/epcsums/samesum.htm.

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

>

>

>