Changes in Gut Microbiota and Systemic Inflammation after Synbiotic Supplementation in Patients with Systemic Lupus Erythematosus: A Randomized, Double-Blind, Placebo-Controlled Trial

Widhani A, Djauzi S, Suyatna FD, Dewi BE

Published in Cells, Vol. 11 (21)

Methodology

Randomised, double-blind, placebo-controlled trial in 46 adults aged 18-60 with SLE and gastrointestinal symptoms in Jakarta (pregnancy, breastfeeding, antibiotics and prednisone above 20 mg/day excluded): a synbiotic capsule (3 x 10^9 CFU of Lactobacillus helveticus R0052, Bifidobacterium infantis R0033 and Bifidobacterium bifidum R0071, plus 80 mg fructo-oligosaccharides) or a lactose placebo once daily for 60 days. Outcomes: faecal microbiota, hs-CRP, IL-6, IL-17 and SLEDAI-2K.

Key Findings

23 randomised per group; 21 synbiotic and 22 placebo patients analysed. hs-CRP did not change on the synbiotic (1.8 to 2.1 mg/L, p=0.23) but rose on placebo (1.75 to 3.75 mg/L, p=0.005). IL-6 fell on the synbiotic (8.76 to 6.59, p=0.02); IL-17 did not change. Median SLEDAI-2K fell from 14 to 8 on the synbiotic (p<0.001) and was unchanged on placebo (9 to 9, p=0.31). One patient per group reported abdominal pain.

Conclusions

The authors conclude that 60 days of synbiotic supplementation may reduce systemic inflammation and disease activity and change gut microbiota in SLE.

Limitations

Small and short; results are reported as before-after changes within each group; baseline median SLEDAI-2K was higher in the synbiotic group (14 vs 9), which the authors say may have affected the result; a single centre.