Oral probiotic supplementation to alleviate diarrhea induced by fluoropyrimidines or irinotecan-based chemotherapy: A systematic review and meta-analysis

IF 3.3 3区医学 Q1 INTEGRATIVE & COMPLEMENTARY MEDICINE

Complementary therapies in medicine Pub Date : 2025-02-22 DOI:10.1016/j.ctim.2025.103151

Tippawan Siritientong , Daylia Thet , Nattawut Leelakanok , Nutthada Areepium

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引用次数: 0

Abstract

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.

Systematic review registration

PROSPERO database (CRD42023473324)

查看原文本刊更多论文

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。

背景：氟嘧啶和伊立替康引起腹泻，在某些情况下可能特别严重。补充益生菌是治疗化疗引起的腹泻的潜在选择。本研究旨在评价益生菌治疗以氟嘧啶或伊立替康为基础化疗的癌症患者腹泻的疗效和安全性。方法：于2023年8月在Cochrane Library、PubMed、ScienceDirect、SciFinder和Scopus进行文献检索。纳入了接受5-氟尿嘧啶、卡培他滨或伊立替康治疗的癌症患者的观察性和前瞻性研究。使用RevMan （version 5.4.1）软件进行统计分析。研究方案已在PROSPERO中注册。结果：在9400份记录中，分别有24项和14项研究被纳入系统评价和荟萃分析。大多数研究从化疗周期的开始到完成给患者提供益生菌菌株的组合。补充益生菌可显著降低各级腹泻(RR = 0.40；95% ci: 0.27, 0.60；P < 0.00001, I2: 0%)、恶心呕吐(RR = 0.49；95% ci [0.37, 0.67]；P < 0.00001, I2: 0%)、腹胀(RR = 0.27；95% ci [0.11, 0.69]；P = 0.006, I2: 0%)和厌食症(RR = 0.62: 95% CI [0.43, 0.90]；P = 0.01, I2: 39%)。绝对风险降低（ARR）范围为22.7%至28.5%，需要治疗的数量（NNT）值为3至5。此外，益生菌改善肠道微生物平衡和生活质量的症状量表。结论：在接受氟嘧啶或伊立替康治疗方案的癌症患者中，补充益生菌是一种很有希望的治疗放化疗引起的腹泻的选择，而且没有严重的副作用。鉴于临床上有意义的ARR和有利的NNT值，益生菌可能在临床实践中发挥作用。然而，需要更大规模的试验来标准化益生菌菌株、剂量、持续时间和目标患者亚群。系统评价注册：PROSPERO数据库（CRD42023473324）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Complementary therapies in medicine 医学-全科医学与补充医学

CiteScore

8.60

自引率

2.80%

发文量

101

审稿时长

112 days

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.