ORLANDO -- The use of probiotics was not associated with significant improvements in the maintenance of remission in patients with ulcerative colitis, a Cochrane systematic review found.
In four studies that compared probiotics with mesalazine, the likelihood of clinical or endoscopic relapse did not differ between the two treatments (OR 1.29, 95% CI 0.92-1.80, P=0.46, I 2=0%), according to , of the University of Central Lancashire in Preston, England.
In addition, in two small studies that included 92 patients, there was no difference in maintenance of remission between probiotics and placebo (OR 0.56, 95% CI 0.22-1.40), Gordon reported in a poster session at the here.
Currently available maintenance therapies for ulcerative colitis are associated with multiple adverse events, and better tolerated therapies are clearly needed.
Because the alterations in the intestinal flora has been implicated in the pathogenesis of the disease, "it has been suggested that modifying the bacterial flora with probiotics may attenuate the inflammatory process and prevent relapses in ulcerative colitis," the researchers explained.
They had that included only four studies and concluded that there was "insufficient evidence" to draw conclusions about the efficacy of probiotics for maintenance of remission in ulcerative colitis. But further research has been published, so they have now performed an updated review.
Studies eligible for inclusion were randomized controlled trials that evaluated probiotics against any intervention or placebo for at least 3 months. Patients could be classified as being in remission according to clinical, histologic, or endoscopic criteria.
Seven trials that included 887 patients were analyzed.
During follow-up periods that ranged from 3 to 12 months, there were 140 relapse events among patients receiving probiotics and 128 among those given mesalazine.
In , 187 patients had been randomized to receive mesalazine, 2,400 mg/day, Lactobacillus GG 18 x 109 bacteria/day, or both for 1 year.
During follow-up, 10 patients in the probiotics group relapsed, as did 12 in the mesalazine group and 10 in the combination group (P=0.77), although time to relapse was longer for patients receiving the probiotics.
Gordon and colleagues also compared the adverse events in the studies of probiotics versus mesalazine, and found no significant difference, with 80 events in the probiotics group and 75 in the mesalazine group (OR 1.16, 95% CI 0.79-1.71, P=0.42).
Despite no clear difference being seen in efficacy in studies available to date, the reviewers called for further research to "explore the potential for probiotics in this context."
Primary Source
Advances in Inflammatory Bowel Diseases
Gordon M, et al "Probiotics for maintenance of remission in ulcerative colitis: a Cochrane systematic review" AIBD 2015; Abstract P054.