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

IF 4.6 2区医学 Q2 ALLERGY Clinical and Translational Allergy Pub Date : 2023-12-04 DOI:10.1002/clt2.12318

Peiwen Xue, Haiyan Qin, Di Qin, Huilin Liu, Juan Li, Rongjiang Jin, Xianjun Xiao

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Abstract

Background

Atopic dermatitis (AD) is a common skin disease that is hard to completely cure in a short time. Guidelines recommend the use of topical corticosteroids (TCS) as first-line anti-inflammatory therapy for AD, but long-term use has significant side effects. Microecological agents (MA), including probiotics, prebiotics and synbiotics, have been widely reported as a potential adjunctive therapy of AD, but whether MA can contribute to AD treatment is currently controversial. Therefore, we conducted a systematic review and meta-analysis to investigate whether MA as an add-on therapy for AD has synergistic and attenuated effects and to further understand the role of MA in clinical interventions for AD.

Methods

We systematically searched Medline, Embase, Web of Science, Cochrane Library and PsycINFO databases up to Apr 11, 2023, and bibliographies were also manually searched, for potentially relevant studies regarding MA as additional therapy of AD. The Cochrane Risk of Bias Tool for assessing risk of bias was used to assess the quality of randomized controlled trials (RCTs). Two reviewers screened studies, extracted data, and evaluated the risk of bias independently. The primary outcomes (SCORAD scores and the number of adverse events) and the secondary outcomes (pruritus scores, the quality of life and the frequency of TCS) were extracted from each article. The data were combined and analyzed to quantify the safety and efficacy of the treatment. R (V4.4.3) software was used for data synthesis. The certainty of the evidence was evaluated with the Grade of Recommendation, Assessment, Development and Evaluation (GRADE) system. We also performed a trial sequential analysis to assess the reliability of the evidence.

Results

A total of 21 studies, including 1230 individuals, were identified, 20 of which met the eligibility criteria for the meta-analysis. Our pooled meta-analyses showed that compared with controls, oral MA as an add-on therapy was associated with significantly lower SCORAD scores (MD = −5.30, 95% CI −8.50, −1.55, p < 0.01, I² = 81%). 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).

Conclusions

This meta-analysis showed that MA plus TCS could be an effective and safe treatment for patients with AD to relieve relevant symptoms, which might be used as an add-on therapy in the treatment of AD. However, due to the limited number of studies, results should be interpreted with caution. Further studies with a larger sample size are needed to explore the optimal protocol of MA plus TCS.

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口服微生态制剂作为特应性皮炎附加治疗的疗效和安全性:随机临床试验的系统回顾和荟萃分析

特应性皮炎(AD)是一种常见病，短期内难以完全治愈。指南推荐使用局部皮质类固醇(TCS)作为AD的一线抗炎治疗，但长期使用有明显的副作用。微生态制剂(Microecological agents, MA)，包括益生菌、益生元和合成制剂，已被广泛报道为AD的潜在辅助治疗方法，但MA是否有助于AD的治疗目前存在争议。因此，我们进行了一项系统综述和荟萃分析，以研究MA作为AD的附加治疗是否具有协同和减毒作用，并进一步了解MA在AD临床干预中的作用。方法系统检索截至2023年4月11日的Medline、Embase、Web of Science、Cochrane Library和PsycINFO数据库，并人工检索文献，寻找MA作为AD附加治疗的潜在相关研究。使用Cochrane偏倚风险评估工具评估随机对照试验(rct)的质量。两位审稿人筛选研究、提取数据并独立评估偏倚风险。从每篇文章中提取主要结局(SCORAD评分和不良事件数量)和次要结局(瘙痒评分、生活质量和TCS频率)。这些数据被合并和分析，以量化治疗的安全性和有效性。采用R (V4.4.3)软件进行数据综合。采用推荐、评估、发展和评价等级(Grade)系统评价证据的确定性。我们还进行了试验序列分析，以评估证据的可靠性。结果共纳入21项研究，包括1230名个体，其中20项符合meta分析的资格标准。我们的汇总荟萃分析显示，与对照组相比，口服MA作为附加治疗与SCORAD评分显著降低相关(MD = - 5.30, 95% CI - 8.50， - 1.55, p <0.01, i2 = 81%)。然而，在这项荟萃分析研究中，不良事件、瘙痒评分、生活质量和TCS使用频率没有显着差异(p >0.05)。结论本荟萃分析显示，MA联合TCS可有效、安全地缓解AD患者的相关症状，可作为AD治疗的一种附加疗法。然而，由于研究数量有限，结果应谨慎解释。MA + TCS的最佳方案需要更大样本量的进一步研究。

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来源期刊

Clinical and Translational Allergy Immunology and Microbiology-Immunology

CiteScore

7.50

自引率

4.50%

发文量

117

审稿时长

12 weeks

期刊介绍： Clinical and Translational Allergy, one of several journals in the portfolio of the European Academy of Allergy and Clinical Immunology, provides a platform for the dissemination of allergy research and reviews, as well as EAACI position papers, task force reports and guidelines, amongst an international scientific audience. Clinical and Translational Allergy accepts clinical and translational research in the following areas and other related topics: asthma, rhinitis, rhinosinusitis, drug hypersensitivity, allergic conjunctivitis, allergic skin diseases, atopic eczema, urticaria, angioedema, venom hypersensitivity, anaphylaxis, food allergy, immunotherapy, immune modulators and biologics, animal models of allergic disease, immune mechanisms, or any other topic related to allergic disease.