PHILADELPHIA — The probiotic VSL#3 and fecal microbiota transplantation could help induce remission in patients with ulcerative colitis, according to a systematic review and meta-analysis of randomized controlled trials.
There is “abundant evidence” that the intestinal microbiome plays an integral role in the pathogenesis of ulcerative colitis, said Mina Fransawy Alkomos, MD, from New York City Health and Hospitals Corporation and Ain Shams University, Cairo.
Several studies have shown that strategies to manipulate the microbiome — through diet, probiotics, antibiotics, or fecal microbiota transplantation — might modulate disease activity, but the results are “controversial,” he told Medscape Medical News.
To clarify the role of microbiota treatment for ulcerative colitis, the researchers reviewed 16 relevant randomized controlled trials that used markedly different protocols. Alkomos presented the results during a poster session here at the American College of Gastroenterology 2018 Annual Scientific Meeting.
“Overall, probiotics were effective for clinical remission and clinical response in ulcerative colitis. And when we divided it to see which probiotic actually was effective, FMT was number one and VSL#3 was number two,” Alkomos told Medscape Medical News.
| Table. Outcomes With Three Different Interventions | |||||
| Outcome | Intervention Group, % | Placebo Group, % | Odds Ratio | PValue | |
|---|---|---|---|---|---|
| Probiotics | |||||
| Clinical remission | 50.5 | 31.9 | 2.10 | <.001 | |
| Endoscopic remission | 52.2 | 46.2 | 1.42 | .17 | |
| Clinical response | 59.0 | 40.6 | 2.12 | <.01 | |
| Fecal microbiota transplantation | |||||
| Clinical remission | 41.6 | 19.4 | 2.88 | <.001 | |
| Clinical response | 45.6 | 35.3 | 1.92 | .024 | |
| VSL#3 | |||||
| Clinical remission | 60.0 | 38.8 | 2.72 | <.01 | |
“The problem that we have with the studies is the diversity of probiotics,” said Alkomos, who cautioned that more study is needed.
“The studies to date are of pretty poor quality,” said Nicholas Talley, MD, Ph.D., from the Mayo Clinic in Rochester, Minnesota, and the University of Newcastle in Australia, who was not involved in the study.
“They used different combinations and amounts of bacteria, and we really don’t know which combination is best. That’s really the problem,” he told Medscape Medical News.
Some studies now show that many people do not retain probiotics. “There are a lot of data now indicating that only a subset of people have any retention at all of anything they take,” he said.
Although there is a “signal of benefit” in this analysis, “I think the data in ulcerative colitis are unconvincing to date,” Talley said. “VSL#3 does have some benefit in pouchitis, where 50% of patients have inflammation, and probiotics can help,” he added.
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