A Cochrane review [Abstract] 1 included 4 studies with a total of 656 subjects. For pain, the analysis indicated a small SMD of -0.17 (95% CI -0.34 to 0.01; 2 studies, n=533), corresponding to a difference in pain scores between SAMe and placebo of 0.4 cm on a 10 cm VAS. For function, the analysis suggested a SMD of 0.02 (95% CI -0.68 to 0.71; statistical heterogeneity I2 = 54%; 3 studies, n=542). The meta-analyses of the number of patients experiencing any adverse event, and withdrawals or drop-outs due to adverse events, resulted in relative risks of 1.27 (95% CI 0.94 to 1.71; 4 studies, n=623) and 0.94 (95% CI 0.48 to 1.86; 4 studies, n=656), respectively. No trial provided information concerning the occurrence of serious adverse events.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding and inadequate intention-to-treat adherence), by inconsistency (variability in results across studies), and by imprecise results (limited study size for each comparison).
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