Variations of plasma apolipoproteins Ai and B induced in liver patients by infusions of S-adenosyl-L-methionine

WITHDRAWN: S-adenosyl-L-methionine for alcoholic liver diseases

The review is withdrawn as it was abandoned and has not been updated since its last edition in 2008. A new team of authors resumed the work on the review, and so far, a major update to the protocol is published. The review is expected to be finalised towards the end of 2016.

The editorial group responsible for this previously published document have withdrawn it from publication.

S-adenosyl-L-methionine for alcoholic liver diseases

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.

S-adenosyl-L-methionine for alcoholic liver diseases

BACKGROUND

Alcohol is a major cause of liver disease in the Western world today. S-adenosyl-L-methionine (SAMe) acts as a methyl donor for all known biological methylation reactions and participates in the synthesis of glutathione, the main cellular anti-oxidant. Randomised clinical trials have addressed the question whether SAMe has any efficacy in patients with alcoholic liver diseases.

OBJECTIVES

The objectives were to assess the efficacy of SAMe on mortality, clinical symptoms, complications, liver biochemistry, and liver histology in patients with alcoholic liver diseases. Adverse events were also analysed.

SEARCH STRATEGY

The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Library, MEDLINE, EMBASE, and full text searches were combined.

SELECTION CRITERIA

Randomised clinical trials studying patients with alcoholic liver diseases were included. Interventions encompassed peroral or parenteral administration of SAMe at any dose versus placebo or no intervention. The trials could be double blind, single blind, or unblinded. The trials could be unpublished or published as an article, an abstract, or a letter, and no language limitations were applied.

DATA COLLECTION AND ANALYSIS

All analyses were performed according to the intention-to-treat method. The statistical package (RevMan and MetaView) provided by the Cochrane Collaboration was used. The methodological quality of the randomised clinical trials was evaluated by components of quality and the Jadad-score.

MAIN RESULTS

Eight placebo-controlled randomised clinical trials including a heterogeneous sample of 330 patients with alcoholic liver disease were identified. Only one trial including 123 patients with alcoholic cirrhosis used adequate methodology and reported clearly on mortality and liver transplantation. It demonstrated no significant effects of SAMe on mortality (Peto odds ratio (OR) 0.53, 95% confidence interval (CI) 0.22 to 1.29), liver related mortality (OR 0.63, 95% CI 0.25 to 1.58), mortality or liver transplantation (OR 0.47; 95% CI 0.20 to 1.09), or patients without complications (OR 0.63, 95% CI 0.30 to 1.31). SAMe was not significantly associated with adverse events (OR 3.95, 95% CI 0.77 to 20.24).

REVIEWER'S CONCLUSIONS

This systematic review could not demonstrate any significant effect of SAMe on mortality, liver related mortality, mortality or liver transplantation, and liver complications of patients with alcoholic liver disease. SAMe should not be used for alcoholic liver disease outside randomised clinical trials.