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Do probiotics have a role in ulcerative colitis?

Pearl Toh
18 Jan 2019

While probiotics may help induce remission in patients with ulcerative colitis (UC), its role in remission maintenance is less certain, suggests two studies presented at AIBD 2018.

“At present, the therapies that exist to treat UC are unfortunately coupled with unfavourable side effects, which has resulted in a demand for new alternatives,” said the researchers.

In a systematic review of 12 randomized studies (of which two involved paediatric population), researchers compared the effects of probiotics vs placebo, probiotics vs 5-aminosalicylic acid (5-ASA), and probiotics plus 5-ASA vs 5-ASA alone in 755 participants with UC. [AIBD 2018, abstract P001]

When compared with placebo, probiotics appeared to improve remission induction in 560 participants analysed (risk ratio [RR], 1.73, 95 percent confidence interval [CI], 1.17–2.56). Disease severity also improved in the probiotic group compared with the placebo group based on two studies (RR, 1.54, 95 percent CI, 1.11–2.13).

Nonetheless, the quality of evidence was low for remission induction and moderate for disease severity, the researchers pointed out.

In addition, adding probiotics to 5-ASA also seemed to improve remission induction compared with 5-ASA alone (RR, 1.22, 95 percent CI, 1.01–1.47), although there was no difference when comparing probiotics alone with 5-ASA (RR, 0.92, 95 percent CI, 0.73–1.16). Again, the researchers noted that these findings were based on low- or very low-quality evidence from just one study for each comparison.

“There is low quality evidence which suggests that probiotics may be efficacious in inducing remission when compared with placebo. Whilst it is uncertain whether probiotics are more effective than 5-ASA, there is limited evidence that they may slightly improve the induction of remission when used in combination with 5-ASA,” concluded the researchers.

“There is insufficient evidence to assess whether probiotics are effective in patients with severe and more extensive disease, or if specific preparations are superior to others,” they added.

In another systematic review by the same investigators looking at maintenance of remission in 11 randomized studies (n=1,204), probiotics were not significantly better in preventing disease relapse compared with placebo (RR, 0.86, 95 percent CI, 0.71–1.04). [AIBD 2018, abstract P002]

Similarly, there was no significant difference in remission maintenance when comparing probiotics vs 5-ASA (RR, 1.05, 95 percent CI, 0.89–1.24) or probiotics plus 5-ASA vs 5-ASA alone (RR, 1.49, 95 percent CI, 0.86–2.57).

However, the researchers acknowledged that the findings were again based on low to very low quality of evidence.

“It is surprising to see that similar issues exist that did in the first review,” said the researchers. “This review highlights the need for further well-designed randomized controlled trials to investigate the above objective. Future research should focus on comparing probiotics with 5-ASA [rather than placebo] as this will reflect clinical practice, [whereby] patients are unlikely to not be on any treatment to maintain remission.”

    

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