The efficacy and safety of oral microecological agents as add-on therapy for atopic dermatitis: A systematic review and meta-analysis of randomized clinical trials
Xue P, et al.
Published in Clinical and Translational Allergy
Methodology
Systematic review and meta-analysis searching Medline, Embase, Web of Science, Cochrane Library and PsycINFO to 11 April 2023 plus manual bibliography searching; two independent reviewers screened, extracted and assessed risk of bias with the Cochrane tool; primary outcomes SCORAD scores and adverse events, secondary outcomes pruritus, quality of life and topical corticosteroid frequency; synthesis in R with GRADE certainty assessment and trial sequential analysis.
Key Findings
Twenty-one studies covering 1,230 people with atopic dermatitis were identified, 20 of them pooled. Adding oral microecological agents (probiotics, prebiotics or synbiotics) to standard treatment significantly lowered SCORAD severity scores compared with controls (mean difference -5.30, 95% CI -8.50 to -1.55, p < 0.01, I-squared 81%). No significant differences were seen in adverse events, itch scores, quality of life or how often topical corticosteroids were needed (all p > 0.05). The authors call for cautious interpretation given the limited number of studies.
Conclusions
Oral probiotics/prebiotics as add-on therapy lowered overall atopic dermatitis severity scores but did not significantly improve pruritus scores or quality of life.
Limitations
Heterogeneity was very high (I-squared 81%) and a 5-point SCORAD reduction is at the edge of clinical relevance; itch, quality of life and steroid use — the outcomes patients notice most — showed no benefit.
Supplements Studied
However, adverse events, pruritus scores, quality of life, and frequency of TCS use showed no significant difference in this meta-analysis study (p > 0.05).
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Study Details
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