Avocado/Soybean Unsaponifiables

Brand names: A1S2, Arthrocen, ASU, Avocado/soybean Unsaponifiables, Piascledine

Usage of Avocado/Soybean Unsaponifiables

Anti-inflammatory effects

Animal and in vitro data

Anti-inflammatory effects have been demonstrated in vitro and in animal studies.(Al-Afify 2018, Christensen 2008, Goudarzi 2018, Henrotin 1998, Kawcak 2007, Lippiello 2008, Oliveira 2016) Several possible mechanisms of action have been described.(Frondoza 2018, Gluszko 2016, Henrotin 2017)

In a murine model of osteoarthritis of the knee, ASU 27.5 mg/kg administered orally daily for 3 weeks attenuated degeneration of the synovium, cartilage, and subchondral bone, as well as decreased the expression of inflammatory mediators such as tumor necrosis factor alpha and matrix metalloproteinase-13, suggesting beneficial structural modifying effects in osteoarthritis.(Al-Afify 2018, Ernst 2003) Additionally, in a rat model of arthritis, ASU administration improved osseointegration, as measured by bone-to-implant contact and bone area between the threads.(dePaula 2018)

In a small study in horses (N=16) with induced osteoarthritis, ASU supplementation did not improve outcomes of pain or lameness; however, the researchers reported reductions in the severity of articular cartilage erosion and synovial hemorrhage, as well as increased articular cartilage glycosaminoglycan synthesis.(Kawcak 2007)

Clinical data

Clinical studies largely support a role for ASU in the treatment of osteoarthritis, due to its anti-inflammatory effects; however, methodological limitations and sponsorship bias exist among studies.(Christiansen 2015, Cornblatt 2016, Ernst 2003) Pain reduction has been reported; however, effectiveness of ASU on structural disease-modifying properties have not been confirmed by radiographic evidence in independent trials.

In a meta-analysis of 4 industry-funded clinical trials conducted prior to 2002 (664 patients with knee and/or hip osteoarthritis), supplemental ASU resulted in improvements in pain scores and functional indices, especially in those with osteoarthritis of the knee.(Christiansen 2008, Ernst 2003)

Further studies similarly report improvements in pain and function. A 6-month multicenter clinical study comparing ASU (ie, Piascledine) with chondroitin in patients with osteoarthritis of the knee (N=364) suggests equivalent efficacy, with decreases in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Index scores noted for both groups. No adverse effects were documented in the study.(Pavelka 2010)

A 3-year, industry-sponsored clinical trial in patients with hip osteoarthritis (N=399) receiving ASU 300 mg/day or placebo suggested a protective effect on the joint with ASU therapy, as measured by change in joint space width over the length of the trial. A lower rate of progression (deterioration) was found in the ASU group (40% vs 50%; P=0.04), but no difference in mean joint space width loss was determined. No differences were found for secondary outcomes of Lequesne Index score, WOMAC pain score, or analgesic or NSAID use.(Maheu 2014)

In an open-label study of 4,822 patients with knee osteoarthritis, the effects of ASU 300 mg daily for 6 months were assessed. The proportion of patients taking NSAIDs or other analgesics decreased from 58.8% at baseline to 24.9% after 6 months of therapy (P<0.001). Additionally, functional impairment, as measured using the Lequesne index, significantly improved from baseline to the final visit (median decrease in score from 8 to 4 points [P<0.001]). ASU was also associated with a significant improvement from baseline in pain intensity (P<0.001).(Gluszko 2016)

In a 6-month clinical study evaluating ASU 300 mg daily versus placebo in patients with osteoarthritis of the temporomandibular joint (N=14), decreases in pain and use of rescue analgesic medication were reported among those receiving ASU.(Catunda 2016)

The European League Against Rheumatism's updated recommendations for the management of hand osteoarthritis (2018) indicated that no evidence for clinical efficacy exists for use of avocado-soybean unsaponifiables.(Kloppenburg 2018)

Antimicrobial effects

Animal data

Coadministration of ASU with praziquantel increased elimination of Schistosoma mansoni in mice.(Soliman 2012)

Metabolic syndrome

Clinical data

ASU did not modify insulin sensitivity in a small clinical study of obese adults (N=7).(Martinez-Abundis 2013)

Wound healing

Animal data

A study in rats suggests anti-inflammatory effects of ASU may be responsible for observed increased collagen synthesis and decreased inflammation during wound healing.(de Oliveira 2013, Oryan 2015)

Avocado/Soybean Unsaponifiables side effects

No clinically important adverse effects have been reported in clinical studies.Catunda 2016, Pavelka 2010 Infrequent mild GI complaints have been documented in reviews, at a similar rate to the comparator or placebo.Christensen 2008, Ernst 2003 In a safety meta-analysis, the adverse effect profile of ASU was similar to that of placebo.Honvo 2019

Before taking Avocado/Soybean Unsaponifiables

Information regarding use of ASU during pregnancy and lactation is lacking. Avocado fruit and soybean are both considered GRAS when used as food.

How to use Avocado/Soybean Unsaponifiables

ASU (eg, Piascledine) dosages of 300 or 600 mg/day (typical duration, 6 months) have been studied for the treatment of osteoarthritis (eg, osteoarthritis of the knee, hip, or temporomandibular joint).Catunda 2016, Gluszko 2016, Maheu 2014, Pavelka 2010

Warnings

Information is limited. A lack of short-term toxicity was reported in in vitro studies of unsaponifiable mixtures.Henrotin 1998 See individual Avocado and Soy monographs.

What other drugs will affect Avocado/Soybean Unsaponifiables

None well documented.

Disclaimer

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