Probiotics linked to remission, recurrence prevention in ulcerative colitis
A new systematic review and meta-analysis of available medical literature suggested probiotics may provide some benefits to patients with ulcerative colitis, but not Crohn’s disease.
In particular, probiotics may be as effective as 5-aminosalicylates for preventing relapse in quiescent UC, and the probiotic medical food VSL#3 (Ferring Pharmaceuticals) appeared effective for inducing remission in active UC.
“Previous meta-analyses have examined the benefit of probiotics in specific subgroups of patients with IBD, but none have synthesized all current available evidence for their role in IBD, and some have important limitations which have been reported previously,” Alex Ford, MD, of the Leeds Gastroenterology Institute at St. James’s University Hospital in the U.K., and colleagues wrote.
To perform an updated examination of the efficacy of probiotics in inflammatory bowel disease, Ford and colleagues reviewed relevant medical literature published up to November 2016, and ultimately included 22 eligible randomized controlled trials comparing probiotics with either 5-ASAs or placebo in adults with IBD.
“We conducted a comprehensive and contemporaneous search and also searched the ‘grey’ literature to maximize the likelihood that all eligible trials examining the effects of probiotics in IBD were included,” they wrote. “This means we have identified RCTs missed by previous meta-analyses, as well as including data from studies published after these meta-analyses were conducted.”
The investigators found probiotics were not superior to placebo for induction of remission in patients with active UC, according to an analysis of seven placebo-controlled trials in which 56.3% of 295 patients who received probiotics vs. 66.3% of 240 who received placebo failed to achieve remission (RR of failure to achieve remission = 0.86; 95% CI, 0.68-1.08).
However, when the analysis was restricted to three trials of VSL#3, 56.2% of 162 patients who received the probiotic failed to achieve remission vs. 75.2% of 118 patients who received placebo, indicating a benefit of VSL#3 over placebo (RR of failure to achieve remission = 0.74; 95% CI, 0.63-0.87). The number needed to treat with VSL#3 to prevent one patient with active UC from failing to achieve remission was five.
Moreover, the investigators found probiotics and 5-ASAs were equally effective for preventing relapse in quiescent UC (RR = 1.02, 95% CI; 0.85-1.23), based on three randomized controlled trials in which 39.7% of 277 patients who received probiotics and 39.2% of 109 patients who received 5-ASAs relapsed.
Conversely, they found no evidence that probiotics were effective for inducing remission in active Crohn’s disease, or preventing relapse in quiescent Crohn’s or after postoperative remission.
“However, the number of studies that have examined this issue is small and further high quality RCTs are required to determine their efficacy in this situation,” Ford and colleagues concluded. “The role of probiotics in subgroups of IBD patients, particularly those with persistent GI symptoms in the absence of inflammation, is uncertain as trials of probiotics for this novel indication are lacking.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.