Different probiotic formulations in ulcerative colitis: A bayesian network meta-analysis

Background: To assess the efficacy and safety of probiotic formulations for the induction of remission in people with ulcerative colitis (UC). Methods: The databases of China national knowledge infrastructure (CNKI), Wanfang Data, Excerpta Medica Database (Embase), Pubmed, and Cochrane Library were searched until May 31, 2022 for randomized clinical trials (RCTs) of patients with UC. Studies had to include 5-aminosalicylate compounds (5-ASAs) as conventional therapy (CON), and 4 listed probiotic formulations used as add on therapy. Trials that recruited patients who was receiving any other treatment were excluded. A network meta-analysis was performed to access and compare different probiotic formulations. Results: 38 RCTs were included. The probiotic formulations participants received included Combined Bifidobacterium, Lactobacillus, Enterococcus and Bacillus Tablets (SLK), Bifid Triple Viable Capsule (BIFICO), Live Combined Bacillus Subtilis and Enterococcus Faecium Enteric-coated Capsules (MCA) and Bacillus licheniformis Granules (ZCS). The results of the network meta-analysis indicate that patients receiving SLK + CON (summary relative risk 1.23, 95% confidence interval 1.14 to 1.33), BIFICO + CON (1.24, 1.16 to 1.32) and MCA + CON (1.16, 1.09 to 1.24) showed a significant difference from CON in overall efficacy, SLK + CON had the highest probability of being the best treatment (surface under the cumulative ranking curve [SUCRA], 0.88). In Mayo score, SLK + CON (standardised mean difference [SMD], 1.73, 0.66 to 2.93), BIFICO + CON (1.70, 0.51 to 2.91) showed a significant difference from CON, and SLK + CON had the highest probability of being the best treatment (SUCRA, 0.83). Except that MCA + CON (relative risks [RR], 0.64, 0.41 to 0.98) showed a lower probability of adverse events compared with CON, there was no significant difference between the other pairwise comparison in terms of safety. Conclusion: Probiotic formulations confer an added benefit in inducing remission combining with 5-ASA over 5-ASA alone. SLK shows advantages in overall efficacy and Mayo score compared with the others.