A service expanscience laboratoires

ASU ExpanscienceTM & osteoarthritis
ASU ExpanscienceTM is supported by clinical studies in individuals:

Impact of ASU on NSAID consumption in patients with symptomatic osteoarthritis of the knee and hip 1

To find out if ASU ExpanscienceTM intake can reduce NSAID consumption in patients with knee or hip osteoarthritis, Blotman et al conducted a randomised, double-blind, placebo-controlled trial. To be included, patients must have had a diagnosis of osteoarthritis for at least six months and regular pain requiring NSAIDs. Those in the 'treatment' group received   ASU ExpanscienceTM in a dose of one 300mg capsule per day or a matched unidentifiable placebo in a dose of one capsule per day. Pain relief with NSAIDs was allowed during the first half of the study and continued if needed during the second half. The investigators measured the therapeutic effect of ASU ExpanscienceTM by recording the number of patients taking NSAIDs in the second half of the study. After three months, results for 163 patients (mean age 63 years) were available.

The investigators found that patients who took ASU ExpanscienceTM were much less likely to restart NSAID treatment compared with those who took placebo - 43.4% vs 69.7%, respectively - at the end of the trial. This result was statistically significant. Also, ASU patients spent more time NSAID-free during the second half of the study. Considerably more ASU patients had improved functionality scores and rated their treatment efficacy to be 'good' or 'very good'. Importantly, ASU ExpanscienceTM were very well tolerated with an incidence of side effects similar to that seen with the inert placebo pill (see figure). 

THE AUTHORS CONCLUDED THAT ASU EXPANSCIENCETM DELIVERED A SLOW ACTING EFFECT ON SYMPTOMS THAT REDUCED THE NEED FOR ADDITIONAL NSAID TREATMENT IN PATIENTS WITH KNEE AND HIP OSTEOARTHRITIS AFTER SIX WEEKS.

Patients taking ASU ExpanscienceTM were less likely to resume NSAID therapy after day 45 (Adapted from Blotman et al.1)

Patients taking ASU ExpanscienceTM were less likely to resume NSAID therapy after day 45 (Adapted from Blotman et al.)


Impact of ASU on pain relief and disability in patients with symptomatic osteoarthritis of the knee and hip 2

Maheu et al 2 conducted a longer-term randomised, double-blind, placebo-controlled trial. In this study the investigators focused on the ability of ASU ExpanscienceTM to improve patients' symptoms. Any residual effects following treatment withdrawal were also reported in order to confirm whether ASU are a slow-acting 'symptomatic' therapy, as suggested by Blotman and colleagues.

One hundred and sixty-four patients (mean age 64 years) with regular, painful knee or hip osteoarthritis were randomised to receive either ASU ExpanscienceTM in a dose of one 300mg capsule per day or a matched unidentifiable placebo pill for six months. Patients had to be NSAID-free for 15 days before entering the study. The overall therapeutic effect of ASU was measured by rating changes in patient functioning during the trial, which includes parameters such as pain and impairment in daily activities.

At the end of the study, the patients who took ASU ExpanscienceTM were better able to function and had less pain compared with those taking placebo. These results were statistically significant. Also, fewer patients receiving ASU ExpanscienceTM found they needed NSAIDs compared with placebo (48% vs 63%, respectively). Reduced levels of disability were also seen with ASU. Tolerability was considered to be "good to excellent" and similar in both groups. A persistent treatment effect was noted at month 8 (see figure).

THE AUTHORS CONCLUDED THAT ASU IMPROVED SYMPTOMS IN KNEE AND HIP OSTEOARTHRITIS AFTER TWO MONTHS, WITH EFFICACY CONTINUING AFTER TREATMENT STOPPED.

Beneficial effects on pain and functional disability persisted up to month 8 (Adapted from MAHEU et al. 1)

Beneficial effects on pain and functional disability persisted up to month 8 (Adapted from MAHEU et al.)


Symptomatic efficacy of ASU in patients with osteoarthritis of the knee and hip 3 ,4

The clinical trials that investigated the effects of ASU in osteoarthritis are considered to be of high quality 3, 4.  There are currently four key randomised, double-blind, placebo-controlled studies involving 750 patients (ITT: n=664) with knee (58.6%) or hip (41.4%) osteoarthritis. The average trial length was six months 3, 4. An independent meta-analysis of these trials by Christensen et al 5  revealed therapeutic benefits with ASU 300mg/day over placebo. Pain reduction significantly favoured ASU – overall, a 10.7% and 11.3% reduction in visual analogue scale (VAS) pain scores was seen in knee and hip osteoarthritis, respectively. Also, Lequesne functional index improvement significantly favoured ASU, which is supportive of treatment efficacy. Patients were twice as likely to respond to ASU therapy, and it is estimated that on a major public health scale one patient in six treated will benefit. Furthermore, there was no evidence of significant side effects with ASU.


Structural effect of ASU in patients with osteoarthritis of the hip 5

The structural effect of ASU ExpanscienceTM in hip osteoarthritis was investigated for the first time as a primary outcome according to the highest recommended methodological and statistical standards of OARSI and OMERACT. The ERADIAS study was a prospective, multicenter, randomized, double blind, parallel group, placebo controlled 3-year trial. A total of 399 patients, aged 45 to 75 years old, with primary hip osteoarthritis according to ACR clinical and radiographic criteria were randomised to receive ASU ExpanscienceTM (n=189) or placebo (n=210) once daily for 3 years. After 3 years of treatment with ASU ExpanscienceTM, the relative risk of joint space width (JSW) progression (>0.50mm) was reduced by 20% compared to placebo (p=0.039) (see figure). Adjusted mean change in JSW at year 3 at the site of maximal narrowing was not significantly different between the two groups. No difference was found regarding the secondary endpoints. Safety was "excellent". The most frequent adverse events were musculoskeletal/connective tissue and infections/infestations.

THE AUTHORS CONCLUDED THAT 3-YEAR TREATMENT WITH ASU EXPANSCIENCETM REDUCED BY 20% THE PERCENTAGE OF JSW PROGRESSORS, INDICATING A POTENTIAL STRUCTURE-MODIFYING EFFECT IN HIP OSTEOARTHRITIS.   

Patients with disease progression at 3 years 

Patients with disease progression at 3 years 

 

1. Blotman F, Maheu E, Wulwik A, Caspard H, Lopez A. Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. A prospective, multicenter, three month, randomized, double blind, placebo controlled trial. Rev Rhum (Engl Ed) 1997; 64: 825 34.
2. Maheu E, Mazières B, Valat JP, Loyau G, Le Loët X, Bourgeois P et al. Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip: A prospective, randomized, double blind, placebo controlled, multicenter clinical trial with a six month treatment period and a two month follow up demonstrating a persistent effect. Arthritis Rheum 1998; 41: 81 91.
3. Ernst E. Avocado soybean unsaponifiables (ASU) for osteoarthritis – a systematic review. Clin Rheumatol 2003; 22: 285 88.
4. Christensen R, Bartels EM, Astrup A, Bliddal H. Review. Symptomatic efficacy of avocadosoybean unsaponifiables (ASU) in osteoarthritis (OA) patients: a meta analysis of randomized controlled trials. Osteoarthritis Cartilage 2008; 16: 399 408.
5. Maheu et al., Ann Rheum Dis. 2014; 73: 376-84.