Comparative efficacy and tolerability of probiotic, prebiotic, and synbiotic formulations for adult patients with mild-moderate ulcerative colitis in an adjunctive therapy: A network meta-analysis

Siyu Zhou; Mengjuan Wang; Wenhui Li; Yun Zhang; Tianyu Zhao; Qianqian Song; Jing Cong

doi:10.1016/j.clnu.2023.11.010

Comparative efficacy and tolerability of probiotic, prebiotic, and synbiotic formulations for adult patients with mild-moderate ulcerative colitis in an adjunctive therapy: A network meta-analysis

Clin Nutr. 2024 Jan;43(1):20-30. doi: 10.1016/j.clnu.2023.11.010. Epub 2023 Nov 15.

Authors

Siyu Zhou¹, Mengjuan Wang², Wenhui Li³, Yun Zhang¹, Tianyu Zhao¹, Qianqian Song¹, Jing Cong⁴

Affiliations

¹ College of Marine Science and Biological Engineering, Qingdao University of Science and Technology, Qingdao 266000, China.
² Emergency Department, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao 266000, China.
³ Department of Oncology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao 266000, China.
⁴ College of Marine Science and Biological Engineering, Qingdao University of Science and Technology, Qingdao 266000, China. Electronic address: 03670@qust.edu.cn.

PMID: 37995508
DOI: 10.1016/j.clnu.2023.11.010

Abstract

Background & aims: Probiotics, prebiotics, and synbiotics (PPS) have been widely used as adjuvant treatments in patients with ulcerative colitis (UC) in recent years. However, the most effective formulations of PPS have yet to be identified. We thus aimed to compare the efficacy and tolerability of different PPS formulations for mild-moderate UC.

Methods: We searched PubMed, Embase, Web of Science, and Cochrane CENTRAL from inception to June 24, 2023 for double-blind randomized controlled trials. We used a frequentist approach in random-effects models for network meta-analysis and the Grading of Recommendations Assessment, Development, and Evaluation approach to evaluate the certainty of evidence.

Results: We analysed data from 20 trials involving 1153 patients. The combinations of specific strains of Lactobacillus and Bifidobacterium (CLB) (odds ratio (OR), 3.85; 95 % confidence interval (CI), 1.40-10.60; low certainty) and combinations of specific strains of Lactobacillus, Bifidobacterium, and Streptococcus (CLBS) (OR, 2.20; 95 % CI, 1.47-3.28; low certainty) significantly increased the clinical remission rate in intention-to-treat analysis (ITT) when compared to placebo. Similarly, compared with placebo, the two combinations significantly reduced clinical activity scores (standardized mean difference (SMD), -1.17 (95 % CI, -1.68 to -0.65), low certainty; and SMD, -1.33 (95 % CI, -1.81 to -0.86), low certainty, respectively). Hierarchical cluster analyses showed the two combinations formed clusters with high efficacy (clinical remission in ITT and clinical activity score) and tolerability (withdrawal due to worsening symptoms) within 12 weeks.

Conclusion: In this systematic review, we found CLB and CLBS demonstrated a clinical benefit in adjuvant treatments, with a comparable tolerability and safety profile to placebo. Further trials are needed.

Trial registration number: CRD42022344905.

Keywords: Efficacy; Prebiotics; Probiotics; Synbiotics; Tolerability; Ulcerative colitis.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Colitis, Ulcerative* / drug therapy
Humans
Network Meta-Analysis
Prebiotics
Probiotics* / adverse effects
Randomized Controlled Trials as Topic
Remission Induction
Synbiotics*

Substances

Prebiotics