{"title":"口服益生菌补充剂缓解氟嘧啶类药物或伊立替康化疗引起的腹泻：系统综述和荟萃分析。","authors":"Tippawan Siritientong , Daylia Thet , Nattawut Leelakanok , Nutthada Areepium","doi":"10.1016/j.ctim.2025.103151","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Fluoropyrimidines and irinotecan cause diarrhea, which can be particularly severe in some cases. Probiotic supplementation is a potential option for managing chemotherapy-induced diarrhea. This study aims to evaluate the efficacy and safety of probiotics in managing diarrhea induced by fluoropyrimidine or irinotecan-based chemotherapy in cancer patients.</div></div><div><h3>Methods</h3><div>A literature search was conducted in Cochrane Library, PubMed, ScienceDirect, SciFinder, and Scopus in August 2023. Observational and prospective studies of cancer patients receiving 5-fluorouracil, capecitabine, or irinotecan were included. RevMan (version 5.4.1) was used for statistical analysis. The study protocol was registered in PROSPERO.</div></div><div><h3>Results</h3><div>Of the 9400 records, 24 and 14 studies were included in the systematic review and meta-analysis, respectively. Most studies provided a combination of probiotic strains to patients from the initiation to the completion of chemotherapy cycles. Probiotic supplementation significantly reduced all grade diarrhea (RR = 0.40; 95 % CI: 0.27, 0.60; <em>P</em> < 0.00001, I<sup>2</sup>: 0 %), nausea and vomiting (RR = 0.49; 95 % CI [0.37, 0.67]; <em>P</em> < 0.00001, I<sup>2</sup>: 0 %), bloating (RR = 0.27; 95 % CI [0.11, 0.69]; <em>P</em> = 0.006, I<sup>2</sup>: 0 %) and anorexia (RR = 0.62: 95 % CI [0.43, 0.90]; <em>P</em> = 0.01, I<sup>2</sup>: 39 %) compared to controls. Absolute risk reductions (ARR) ranged from 22.7 % to 28.5 %, with the number needed to treat (NNT) value of 3–5. Moreover, probiotics improved intestinal microbial balance and symptom scales of quality of life.</div></div><div><h3>Conclusions</h3><div>Probiotic supplementation is a promising option to manage chemoradiotherapy-induced diarrhea without serious side effects in cancer patients receiving fluoropyrimidines or irinotecan-based regimens. Given the clinically meaningful ARR and favorable NNT values, probiotics may have a role in clinical practice. However, larger trials are needed to standardize probiotic strain, dosage, duration, and target patient subgroups.</div></div><div><h3>Systematic review registration</h3><div>PROSPERO database (CRD42023473324)</div></div>","PeriodicalId":10545,"journal":{"name":"Complementary therapies in medicine","volume":"89 ","pages":"Article 103151"},"PeriodicalIF":3.3000,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Oral probiotic supplementation to alleviate diarrhea induced by fluoropyrimidines or irinotecan-based chemotherapy: A systematic review and meta-analysis\",\"authors\":\"Tippawan Siritientong , Daylia Thet , Nattawut Leelakanok , Nutthada Areepium\",\"doi\":\"10.1016/j.ctim.2025.103151\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Fluoropyrimidines and irinotecan cause diarrhea, which can be particularly severe in some cases. Probiotic supplementation is a potential option for managing chemotherapy-induced diarrhea. This study aims to evaluate the efficacy and safety of probiotics in managing diarrhea induced by fluoropyrimidine or irinotecan-based chemotherapy in cancer patients.</div></div><div><h3>Methods</h3><div>A literature search was conducted in Cochrane Library, PubMed, ScienceDirect, SciFinder, and Scopus in August 2023. Observational and prospective studies of cancer patients receiving 5-fluorouracil, capecitabine, or irinotecan were included. RevMan (version 5.4.1) was used for statistical analysis. The study protocol was registered in PROSPERO.</div></div><div><h3>Results</h3><div>Of the 9400 records, 24 and 14 studies were included in the systematic review and meta-analysis, respectively. Most studies provided a combination of probiotic strains to patients from the initiation to the completion of chemotherapy cycles. Probiotic supplementation significantly reduced all grade diarrhea (RR = 0.40; 95 % CI: 0.27, 0.60; <em>P</em> < 0.00001, I<sup>2</sup>: 0 %), nausea and vomiting (RR = 0.49; 95 % CI [0.37, 0.67]; <em>P</em> < 0.00001, I<sup>2</sup>: 0 %), bloating (RR = 0.27; 95 % CI [0.11, 0.69]; <em>P</em> = 0.006, I<sup>2</sup>: 0 %) and anorexia (RR = 0.62: 95 % CI [0.43, 0.90]; <em>P</em> = 0.01, I<sup>2</sup>: 39 %) compared to controls. Absolute risk reductions (ARR) ranged from 22.7 % to 28.5 %, with the number needed to treat (NNT) value of 3–5. Moreover, probiotics improved intestinal microbial balance and symptom scales of quality of life.</div></div><div><h3>Conclusions</h3><div>Probiotic supplementation is a promising option to manage chemoradiotherapy-induced diarrhea without serious side effects in cancer patients receiving fluoropyrimidines or irinotecan-based regimens. Given the clinically meaningful ARR and favorable NNT values, probiotics may have a role in clinical practice. However, larger trials are needed to standardize probiotic strain, dosage, duration, and target patient subgroups.</div></div><div><h3>Systematic review registration</h3><div>PROSPERO database (CRD42023473324)</div></div>\",\"PeriodicalId\":10545,\"journal\":{\"name\":\"Complementary therapies in medicine\",\"volume\":\"89 \",\"pages\":\"Article 103151\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-02-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Complementary therapies in medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0965229925000263\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INTEGRATIVE & COMPLEMENTARY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Complementary therapies in medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0965229925000263","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INTEGRATIVE & COMPLEMENTARY MEDICINE","Score":null,"Total":0}
Oral probiotic supplementation to alleviate diarrhea induced by fluoropyrimidines or irinotecan-based chemotherapy: A systematic review and meta-analysis
Background
Fluoropyrimidines and irinotecan cause diarrhea, which can be particularly severe in some cases. Probiotic supplementation is a potential option for managing chemotherapy-induced diarrhea. This study aims to evaluate the efficacy and safety of probiotics in managing diarrhea induced by fluoropyrimidine or irinotecan-based chemotherapy in cancer patients.
Methods
A literature search was conducted in Cochrane Library, PubMed, ScienceDirect, SciFinder, and Scopus in August 2023. Observational and prospective studies of cancer patients receiving 5-fluorouracil, capecitabine, or irinotecan were included. RevMan (version 5.4.1) was used for statistical analysis. The study protocol was registered in PROSPERO.
Results
Of the 9400 records, 24 and 14 studies were included in the systematic review and meta-analysis, respectively. Most studies provided a combination of probiotic strains to patients from the initiation to the completion of chemotherapy cycles. Probiotic supplementation significantly reduced all grade diarrhea (RR = 0.40; 95 % CI: 0.27, 0.60; P < 0.00001, I2: 0 %), nausea and vomiting (RR = 0.49; 95 % CI [0.37, 0.67]; P < 0.00001, I2: 0 %), bloating (RR = 0.27; 95 % CI [0.11, 0.69]; P = 0.006, I2: 0 %) and anorexia (RR = 0.62: 95 % CI [0.43, 0.90]; P = 0.01, I2: 39 %) compared to controls. Absolute risk reductions (ARR) ranged from 22.7 % to 28.5 %, with the number needed to treat (NNT) value of 3–5. Moreover, probiotics improved intestinal microbial balance and symptom scales of quality of life.
Conclusions
Probiotic supplementation is a promising option to manage chemoradiotherapy-induced diarrhea without serious side effects in cancer patients receiving fluoropyrimidines or irinotecan-based regimens. Given the clinically meaningful ARR and favorable NNT values, probiotics may have a role in clinical practice. However, larger trials are needed to standardize probiotic strain, dosage, duration, and target patient subgroups.
期刊介绍：
Complementary Therapies in Medicine is an international, peer-reviewed journal that has considerable appeal to anyone who seeks objective and critical information on complementary therapies or who wishes to deepen their understanding of these approaches. It will be of particular interest to healthcare practitioners including family practitioners, complementary therapists, nurses, and physiotherapists; to academics including social scientists and CAM researchers; to healthcare managers; and to patients. Complementary Therapies in Medicine aims to publish valid, relevant and rigorous research and serious discussion articles with the main purpose of improving healthcare.
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