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Role of methionine containing antioxidant combination in the management of pain in chronic pancreatitis: a systematic review and meta-analysis.
Pancreatology 2015 Mar-Apr; 15(2):136-44P

Abstract

BACKGROUND

Pain in CP results from inflammation and neuroimmune alterations that are associated with oxidative stress, among other mechanisms. This is marked by depletion of antioxidant defenses including methionine, which is a donor of methyl moieties that maintains the acinar transsulfuration pathway. We performed a systematic review and meta-analysis of trials evaluating methionine-containing antioxidants in CP.

PATIENT AND METHODS

Literature search was conducted in Medline/Pubmed, EMBASE, and Cochrane databases. Systematic review and meta-analysis was performed per PRISMA guidelines. Main study outcome was pain relief. GRADE system was used for quality assessment. Heterogeneity was assessed by the Q and I(2) measures; publication bias by Egger's test. Random-effect model (DerSimonian and Laird) was used if there was heterogeneity.

RESULTS

Eight studies (n = 411) were identified that used methionine-containing antioxidants. The study duration ranged from 10 wks to 12 months. All studies used methionine, organic selenium, ascorbate, beta-carotene and alpha-tocoferol. Four studies (including two RCTs) that reported change in pain scores were metaanalyzed. Though overall effect [standardized difference in means (95% CI)] on pain score reduction was -0.95 (-1.738 to -0.160) (z = -2.36; p = 0.018), the significance was lost when the two RCTs were meta-analyzed. RCTs that reported the number of pain free patients had a statistically significant overall effect of -3.204 (p = 0.001). Though more patients on methionine containing antioxidants had adverse events, majority of them were mild.

CONCLUSION

Methionine containing antioxidants appear to result in pain reduction in a significant proportion of CP patients. Further randomized controlled trials with homogeneous outcome measures are needed.

Authors+Show Affiliations

Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India; Asian Healthcare Foundation, Hyderabad, India. Electronic address: rup_talukdar@yahoo.com.Department of Biostatistics, Asian Institute of Gastroenterology, Hyderabad, India.Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

25648074

Citation

Talukdar, Rupjyoti, et al. "Role of Methionine Containing Antioxidant Combination in the Management of Pain in Chronic Pancreatitis: a Systematic Review and Meta-analysis." Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], vol. 15, no. 2, 2015, pp. 136-44.
Talukdar R, Murthy HV, Reddy DN. Role of methionine containing antioxidant combination in the management of pain in chronic pancreatitis: a systematic review and meta-analysis. Pancreatology. 2015;15(2):136-44.
Talukdar, R., Murthy, H. V., & Reddy, D. N. (2015). Role of methionine containing antioxidant combination in the management of pain in chronic pancreatitis: a systematic review and meta-analysis. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], 15(2), pp. 136-44. doi:10.1016/j.pan.2015.01.003.
Talukdar R, Murthy HV, Reddy DN. Role of Methionine Containing Antioxidant Combination in the Management of Pain in Chronic Pancreatitis: a Systematic Review and Meta-analysis. Pancreatology. 2015;15(2):136-44. PubMed PMID: 25648074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of methionine containing antioxidant combination in the management of pain in chronic pancreatitis: a systematic review and meta-analysis. AU - Talukdar,Rupjyoti, AU - Murthy,H V V, AU - Reddy,D Nageshwar, Y1 - 2015/01/21/ PY - 2014/10/06/received PY - 2014/12/27/revised PY - 2015/01/12/accepted PY - 2015/2/5/entrez PY - 2015/2/5/pubmed PY - 2015/12/25/medline KW - Antioxidant combination KW - Chronic pancreatitis KW - Meta-analysis KW - Methionine KW - Pain KW - Systematic review SP - 136 EP - 44 JF - Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] JO - Pancreatology VL - 15 IS - 2 N2 - BACKGROUND: Pain in CP results from inflammation and neuroimmune alterations that are associated with oxidative stress, among other mechanisms. This is marked by depletion of antioxidant defenses including methionine, which is a donor of methyl moieties that maintains the acinar transsulfuration pathway. We performed a systematic review and meta-analysis of trials evaluating methionine-containing antioxidants in CP. PATIENT AND METHODS: Literature search was conducted in Medline/Pubmed, EMBASE, and Cochrane databases. Systematic review and meta-analysis was performed per PRISMA guidelines. Main study outcome was pain relief. GRADE system was used for quality assessment. Heterogeneity was assessed by the Q and I(2) measures; publication bias by Egger's test. Random-effect model (DerSimonian and Laird) was used if there was heterogeneity. RESULTS: Eight studies (n = 411) were identified that used methionine-containing antioxidants. The study duration ranged from 10 wks to 12 months. All studies used methionine, organic selenium, ascorbate, beta-carotene and alpha-tocoferol. Four studies (including two RCTs) that reported change in pain scores were metaanalyzed. Though overall effect [standardized difference in means (95% CI)] on pain score reduction was -0.95 (-1.738 to -0.160) (z = -2.36; p = 0.018), the significance was lost when the two RCTs were meta-analyzed. RCTs that reported the number of pain free patients had a statistically significant overall effect of -3.204 (p = 0.001). Though more patients on methionine containing antioxidants had adverse events, majority of them were mild. CONCLUSION: Methionine containing antioxidants appear to result in pain reduction in a significant proportion of CP patients. Further randomized controlled trials with homogeneous outcome measures are needed. SN - 1424-3911 UR - https://www.unboundmedicine.com/medline/citation/25648074/Role_of_methionine_containing_antioxidant_combination_in_the_management_of_pain_in_chronic_pancreatitis:_a_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1424-3903(15)00015-0 DB - PRIME DP - Unbound Medicine ER -