Efficacy and safety of avocado-soybean unsaponifiables for the treatment of hip and knee osteoarthritis: A systematic review and meta-analysis of randomized placebo-controlled trials

Int J Rheum Dis. 2019 Sep;22(9):1607-1615. doi: 10.1111/1756-185X.13658. Epub 2019 Jul 22.

Abstract

Objective: We performed a systematic review and meta-analysis from randomized controlled trials to examine the efficacy and safety of avocado-soybean unsaponifiables (ASU) in patients with hip or knee osteoarthritis (OA).

Data sources: Medline, SCOPUS, Web of Science, and Google Scholar databases were searched for randomized placebo-controlled trials.

Study selection: Original studies were randomized placebo-controlled trials evaluating the effect of orally administered ASU on knee or hip OA symptoms using the Lequesne index, visual analog scale (VAS) and/or joint space width (JSW).

Data extraction: Meta-analysis was conducted using a random-effects model and generic inverse variance method. Heterogeneity was tested using the I2 statistic index.

Data synthesis: Avocado-soybean unsaponifiables therapy had a significant reduction on pain by VAS assessment (weighted mean difference [WMD]: -9.64 mm, 95% CI: -17.43, -1.84; P = .02; I2 = 92%). A subanalysis according to the type of OA showed that ASU significantly decreased both VAS and Lequesne index in knee OA (WMD: -17.36, 95% CI: -25.91, -8.82; P < .0001; I2 = 87% and WMD: -2.33, 95% CI: -2.88, -1.78; P < .00001; I2 = 18%, respectively) but not in hip OA. Finally, ASU supplementation showed no significant differences for adverse events compared to placebo (relative risk: 1.02, 95% CI: 0.83, 1.25; P = .88; I2 = 0%).

Conclusion: Results of this meta-analysis suggest a beneficial effect of ASU treatment in symptomatic knee OA but not in hip OA. Additionally, adverse events were similar in patients receiving ASU therapy or placebo.

Keywords: Lequesne index; avocado-soybean unsaponifiables; meta-analysis; osteoarthritis; visual analog scale.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / isolation & purification
  • Antirheumatic Agents / therapeutic use*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / diagnosis
  • Osteoarthritis, Hip / drug therapy*
  • Osteoarthritis, Hip / physiopathology
  • Osteoarthritis, Knee / diagnosis
  • Osteoarthritis, Knee / drug therapy*
  • Osteoarthritis, Knee / physiopathology
  • Persea / chemistry*
  • Plant Extracts / adverse effects
  • Plant Extracts / isolation & purification
  • Plant Extracts / therapeutic use*
  • Plant Oils / chemistry*
  • Randomized Controlled Trials as Topic
  • Soybean Oil / chemistry*
  • Treatment Outcome

Substances

  • Antirheumatic Agents
  • Plant Extracts
  • Plant Oils
  • Soybean Oil