Enzyme- bioflavonoid combination shows efficacy for knee pain management

By Stephen Daniells

- Last updated on GMT

© iStock
© iStock

Related tags Non-steroidal anti-inflammatory drug

An oral enzyme combination containing proteolytic enzymes and bioflavonoid may improve measures of pain, function and daily living, says a new meta-analysis of six RCTs.

Data published in the Journal of Pain Research​ indicated that the dietary supplement Wobenzym was as effective as nonsteroidal anti-inflammatory drug (NSAID) Diclofenac for improving knee measures in people with osteoarthritis of the knee.

In addition, the supplement was associated with a significantly lower risk of adverse events compared to the NSAID intervention.

“Our analysis concludes that Wobenzym is a safe and effective alternative to NSAIDs in the management of pain and is better tolerated by patients,”​ said lead researcher Michael Überall, of the Institute of Neurological Sciences in Nuremberg, Germany.

“We are encouraged by the results, which indicate that a safer alternative exists for patients who may have discontinued NSAID use due to adverse effects and still struggle with the pain of osteoarthritis of the knee.”


The oral enzyme combination is sold as the product Wobenzym by Atrium Innovations, which offers healthcare practitioner and specialized retail product brands. The original studies were sponsored by Atrium’s subsidiary Mucos Pharma GmbH & Co. KG, Germany.

Wobenzym is sold as an OTC in Germany where these particular studies were performed. The company does have data supporting the products efficacy in healthy populations, such as in vigorous exercise (which is one of the structure-function claims made on the product label in the US).

Study details

The study authors conducted a meta-analysis of six different double-blind, comparator-controlled intervention studies lasting 3 to 12 weeks of Wobenzym versus NSAIDs in osteoarthritis. The researchers pooled data from 774 patients for subjective pain scores and quality of life measures.

Results showed that both Wobenzym and NSAIDs equally improved scores on the Lequesne algofunctional index (LAFI), a validated questionnaire for the self-assessment of osteoarthritis-related joint pain and functional disability recommended by the US FDA and the European Medicines Agency.

In addition, improvements in an 11-point numeric rating-scale pain intensity improved significantly in both groups, compared to baseline.

Safety and tolerability data showed that the supplement resulted in significantly fewer adverse effects, and virtually no change in key hepatic enzymes, a common side effect of NSAID treatment.

“Based on the results of this IPD [individual patient data] meta-analysis, the beneficial anti-inflammatory and analgesic effects of [Wobenzym] were comparable to those of [Diclofenac,] one of the most prevalently prescribed NSAIDs for osteoarthritis worldwide,” ​wrote the researchers.

Source: Journal of Pain Research
Volume 2016:9, Pages 941-961, doi: 10.2147/JPR.S108563
“Efficacy, tolerability, and safety of an oral enzyme combination vs diclofenac in osteoarthritis of the knee: results of an individual patient-level pooled reanalysis of data from six randomized controlled trials”
Authors:  M.A. Ueberall et al. 

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