No evidence to support or refute S-adenosyl-L-methionine for alcoholic liver diseases

Rambaldi A, Gluud C

Published Online:

January 21, 2009

Alcohol is a major cause for liver diseases. Alcoholic liver injury reduces s-adenosyl-L-methionine (SAMe) synthesis. SAMe acts as a methyl donor and participates in the synthesis of glutathione, the main cellular antioxidant. Randomised clinical trials have compared SAMe versus placebo for alcoholic liver diseases, but the included patients are heterogeneous. The review could not demonstrate significant clinical effects of SAMe on the course of the liver diseases. We need more research before SAMe may be recommended for patients with alcoholic liver diseases.

Abstract (click to read)

Background:

Alcohol is a major cause of liver disease and disrupts methionine and oxidative balances. S-adenosyl-L-methionine (SAMe) acts as a methyl donor for methylation reactions and participates in the synthesis of glutathione, the main cellular antioxidant. Randomised clinical trials have addressed the question whether SAMe may benefit patients with alcoholic liver diseases.

Objectives:

To evaluate the beneficial and harmful effects of SAMe for patients with alcoholic liver diseases.

Search strategy:

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (May 2005), The Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 2, 2005), MEDLINE (1950 to May 2005), EMBASE (1980 to May 2005), and Science Citation Index Expanded (searched May 2005).

Selection criteria:

We included randomised clinical trials studying patients with alcoholic liver diseases. Interventions encompassed per oral or parenteral administration of SAMe at any dose versus placebo or no intervention.

Data collection and analysis:

We performed all analyses according to the intention-to-treat method using RevMan Analyses provided by the Cochrane Collaboration. We evaluated the methodological quality of the randomised clinical trials by quality components.

Main results:

We identified nine randomised clinical trials including a heterogeneous sample of 434 patients with alcoholic liver diseases. The methodological quality regarding randomisation was generally low, but 8 out of 9 trials were placebo controlled. Only one trial including 123 patients with alcoholic cirrhosis used adequate methodology and reported clearly on all-cause mortality and liver transplantation. We found no significant effects of SAMe on all-cause mortality (relative risks (RR) 0.62, 95% confidence interval (CI) 0.30 to 1.26), liver-related mortality (RR 0.68, 95% CI 0.31 to 1.48), all-cause mortality or liver transplantation (RR 0.55; 95% CI 0.27 to 1.09), or complications (RR 1.35, 95% CI 0.84 to 2.16), but the analysis is based mostly on one trial only. SAMe was not significantly associated with non-serious adverse events (RR 4.92; 95% CI 0.59 to 40.89) and no serious adverse events were reported.

Authors' conclusions:

We could not find evidence supporting or refuting the use of SAMe for patients with alcoholic liver diseases. We need more long-term, high-quality randomised trials on SAMe for these patients before SAMe may be recommended for clinical practice.

This record should be cited as:

Rambaldi A, Gluud C. S-adenosyl-L-methionine for alcoholic liver diseases. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD002235. DOI: 10.1002/14651858.CD002235.pub2

Assessed as up to date:

February 21, 2006

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Primary Review Group:

Hepato-Biliary Group

Health topics:

Gastroenterology > Alcohol-related liver disease > Cirrhosis

Gastroenterology > Alcohol-related liver disease > Fatty liver

Complementary & alternative medicine > Gastroenterology > Alcohol-related liver disease

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

No evidence to support or refute S-adenosyl-L-methionine for alcoholic liver diseases

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