S-Adenosyl Methionine

Itching, liver tests

Pain relief, similar by 8w

Depression severity, response/remission

-18.5pp response; +14.1pp remission

Earlier mood improvement

Cholestasis markers, itch

Liver protection, survival

Glutathione ↑; MDA ↓

SAM/SAH ↑; tHcy ↔

Homocysteine/SAM balance

Liver outcomes & survival

SAM/methylation preserved

Homocysteine shifted

SAM↑, cognition↑

DAT↕, no insulin

SAM↑, Hcy↓

Aβ↓, cognition↑

SAM ↑, cognition ↑

DAT/metabolites shift

Pain eased similarly

Function improved; fewer AEs

Month 1: +9.3, +11.6

Pain/function ~equal

+9 to +12 pain

Fewer adverse events

Fatigue/pruritus better

Bilirubin/AP ↓

Lower endotoxin/inflammation

+21.57% response

Endotoxin/MMP-9/IL-18 ↓

Response rate +21.6%