No Clinical Benefit Found with L-methionine Treatment of AIDS-associated Myelopathy

Despite slight improvements in central conduction time, L-methionine treatment benefits none of the clinical measures of AIDS-associated myelopathy (AM) [disturbance or disease of the spinal cord], according to the results of a phase II trial reported in the October 12th issue of Neurology.

In an earlier pilot study, the authors observed clinical and electrophysiologic improvement in some subjects with AM after treatment with high doses of L-methionine.

Based on those preliminary results, Dr. Alessandro Di Rocco from Albert Einstein College of Medicine, New York and colleagues conducted a double-blind, placebo-controlled study of L-methionine in 50 patients with AM. The subjects received L-methionine 6 g/day in two divided doses.

At 12 weeks, patients treated with L-methionine had a mean improvement of 2.9 msec in central conduction time, the authors report, compared with a mean improvement of 0.5 msec among placebo patients. This difference did not reach statistical significance (p=0.17).

There was no difference between placebo and treatment groups in strength, spasticity, and urinary function, the report indicates.

L-methionine treatment was associated with increases in CSF SAM (S-adenosyl-methionine) levels, the researchers note, and the correlation between central conduction time improvement and CSF SAM increase approached significance.

L-methionine was well tolerated, the results indicate, with both groups (L-methionine and placebo) experiencing similar numbers of serious adverse events and overall adverse events.

"This study indicates that L-methionine was well tolerated but ineffective in the treatment of AM," the authors conclude.

"Further studies are warranted to determine whether L-methionine or other methyl group donors can be beneficial in AM."

10/22/04

Neurology 2004;63:1270-1275.