Effects of fish oil supplementation on non-steroidal anti-inflammatory drug requirement in patients with mild rheumatoid arthritis--a double-blind placebo controlled study.

Lau CS, Morley KD, Belch JJ.

Department of Medicine, Ninewells Hospital, Dundee, Scotland.

Maxepa contains eicosapentaenoic acid (EPA) (171 mg/capsule) and docosahexaenoic acid (DHA) (114 mg/capsule).  EPA acts as an alternative substrate to arachidonate, leading to the formation of the less proinflammatory prostaglandins ('3' series) and leukotrienes ('5' series).  If Maxepa has anti-inflammatory properties it could be expected to reduce the requirement for NSAIDs in patients with RA.  This has not been investigated nor has Maxepa therapy been studied over a full 1-yr period.

Sixty-four patients with stable RA requiring NSAID therapy only were studied. Patients received either 10 Maxepa or air-filled placebo capsules per day for 12 months.  All then received placebo capsules for a further 3 months.  Patients were reviewed at 3-monthly intervals.  NSAID requirement at entry visit for each patient was assigned as 100%.  Patients were instructed to slowly reduce their NSAID dosage providing there was no worsening of their symptoms.  Clinical and laboratory parameters of RA activity were also measured.

There was a significant reduction in NSAID usage in patients on Maxepa when compared with placebo from month 3 [mean (95% C.I. for mean) requirement--71.1 (55.9-86.2)% and 89.7 (73.7-105.7)%, respectively].  This effect reached its maximum at month 12 [40.6 (24.5-56.6)% and 84.1 (62.7-105.5)%, respectively] and persisted to month 15 [44.7 (27.6-61.8)% and 85.8 (60.5-111.1)%, respectively] (P < 0.001, ANOVA).

These patients were able to reduce their NSAID requirement without experiencing any deterioration in the clinical and laboratory parameters of RA activity.