P793 Efficacy and safety of probiotics in inflammatory bowel disease: an umbrella review and updated meta-analysis of randomized controlled trials

Abstract

Abstract Background Probiotics hold potential in IBD, yet knowledge gaps persist. We aimed to perform an umbrella review of systematic reviews and updated metanalysis of all RCT assessing the effect of probiotics in on Crohn’s disease (CD) and ulcerative colitis (UC). Methods We searched MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials until September 2023 for systematic reviews and randomized controlled trials (RCT). Primary outcomes were clinical response and remission; secondary outcomes included endoscopic response, remission, and side effects. We calculated odds ratios using a random-effects model in R. Quality was assessed using the AMSTAR-2 (systematic reviews) and Jadad scale (RCTs), the Cochrane Collaboration tool was used to grade trials’ risk of bias. Results Out of 2613 search results, 67 studies (22 systematic reviews and 45 RCTs) met eligibility criteria. In the updated meta-analysis, the OR for clinical remission was 1.88 (95%CI 1.20-2.93, I2=60% - Figure 1). However, the positive effect was statistically significant only for UC (OR 2.00, 95% CI 1.28-3.11, I2=57%) but not for CD. Likewise, probiotics significantly decreased the odds of clinical recurrence in UC patients (OR 0.65, 95%CI 0.42-1.01, I2=52%) and in relapsing pouchitis (OR 0.03, 95%CI 0.00-0.25, I2=64%), but not in CD. The De Simone formulation consistently outperformed other probiotics in achieving remission and preventing recurrence in UC. On the other hand, the use of probiotics was not associated with better endoscopic outcomes. The occurrence of both mild and severe adverse events was comparable to control group. Conclusion Our results support the use of probiotics for patients with UC, both for the induction of clinical remission and for the prevention of relapse, as well for patients with previous diagnosis of pouchitis, and reinforces their good safety profile.