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Meta-Analysis
. 2020 Jul 17;7(7):CD006634.
doi: 10.1002/14651858.CD006634.pub3.

Probiotics for induction of remission in Crohn's disease

Berkeley N Limketkai  1 , Anthony K Akobeng  2 , Morris Gordon  3 , Akinlolu Adedayo Adepoju  4   5
Affiliations
Meta-Analysis

Probiotics for induction of remission in Crohn's disease

Berkeley N Limketkai et al. Cochrane Database Syst Rev. .

Abstract

Background: Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract, in which the pathogenesis is believed to be partly influenced by the gut microbiome. Probiotics can be used to manipulate the microbiome and have therefore been considered as a potential therapy for CD. There is some evidence that probiotics benefit other gastrointestinal conditions, such as irritable bowel syndrome and ulcerative colitis, but their efficacy in CD is unclear. This is the first update of a Cochrane Review previously published in 2008.

Objectives: To assess the efficacy and safety of probiotics for the induction of remission in CD.

Search methods: The following electronic databases were searched: MEDLINE (from inception to 6 July 2020), Embase (from inception to 6 July 2020), the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane IBD Review Group Specialised Trials Register, World Health Organization (WHO) International Clinical Trials Registry, and ClinicalTrials.gov.

Selection criteria: Randomised controlled trials (RCTs) that compared probiotics with placebo or any other non-probiotic intervention for the induction of remission in CD were eligible for inclusion.

Data collection and analysis: Two review authors independently extracted data and assessed the methodological quality of included studies. The primary outcome was clinical remission. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes.

Main results: There were two studies that met criteria for inclusion. One study from Germany had 11 adult participants with mild-to-moderate CD, who were treated with a one-week course of corticosteroids and antibiotics (ciprofloxacin 500 mg twice daily and metronidazole 250 mg three times a day), followed by randomised assignment to Lactobacillus rhamnosus strain GG (two billion colony-forming units per day) or corn starch placebo. The other study from the United Kingdom (UK) had 35 adult participants with active CD (CDAI score of 150 to 450) randomised to receive a synbiotic treatment (comprised of freeze-dried Bifidobacterium longum and a commercial product) or placebo. The overall risk of bias was low in one study, whereas the other study had unclear risk of bias in relation to random sequence generation, allocation concealment, and blinding. There was no evidence of a difference between the use of probiotics and placebo for the induction of remission in CD (RR 1.06; 95% CI 0.65 to 1.71; 2 studies, 46 participants) after six months. There was no difference in adverse events between probiotics and placebo (RR 2.55; 95% CI 0.11 to 58.60; 2 studies, 46 participants). The evidence for both outcomes was of very low certainty due to risk of bias and imprecision.

Authors' conclusions: The available evidence is very uncertain about the efficacy or safety of probiotics, when compared with placebo, for induction of remission in Crohn's disease. There is a lack of well-designed RCTs in this area and further research is needed.

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Conflict of interest statement

Berkeley N Limketkai has no known declarations of interest to declare.

Anthony K Akobeng has no known declarations of interest to declare.

Morris Gordon Since August 2016, I have received travel fees to attend international scientific and training meetings from Pharma companies. These grants included no honoraria, inducement, advisory role or any other relationship and were restricted to the travel and meeting related costs of attending such meetings. These include: DDW (Digestive Disease Week) May 2017, World Congress of Gastroenterology October 2017, DDW May 2018, Advances in IBD December 2018, DDW May 2019. The companies include: Biogaia (2017‐19), Ferring (2018), Allergan (2017), synergy (bankrupt ‐ 2018) and Tillots (2017‐19).None of these companies have had any involvement in any works completed by me and I have never had any payments for any other activites for them, as confirmed below. From these date onwards, I have made a personal undertaking to take no further funds from any pharmaceutical or formula company in any form for travel or other related activities. This is to lift the limitations such funding has on my ability to act as a first and corresponding author on reviews, in line with the Cochrane policies on such matters and is reported in line with these policies. These current declarations will expire over the next 3 years and this statement updated regularly to reflect this.

Akinlolu Adedayo Adepoju has no known declarations of interest to declare.

Figures

1
1
PRISMA study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Probiotics versus placebo, outcome: 1.1 Induction of remission.
1.1
1.1. Analysis
Comparison 1: Probiotics versus placebo, Outcome 1: Induction of remission
1.2
1.2. Analysis
Comparison 1: Probiotics versus placebo, Outcome 2: Adverse events leading to withdrawal
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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