The Efficacy and Safety of Probiotics in People with Cancer: A Systematic Review
A partir d'une revue systématique de la littérature (11 études, 1 557 participantes), cette étude analyse l'efficacité et la sécurité de médicaments probiotiques, utilisés principalement pour traiter les diarrhées sévères, chez les patients atteints de cancer
Background : Probiotics are living microorganisms that are generally thought of as being beneficial to the recipient. They have been shown to be effective in people with acute infectious diarrhoea, and cost-effective in antibiotic-associated diarrhoea. Probiotics may have a role in people with cancer, as various cancer treatments often lead to diarrhoea. However, as people with cancer are often immunocompromised, it is important to assess for adverse events such as infection, which could potentially be a consequence of deliberate ingestion of living microorganisms. Design : A systematic review was performed to collect, analyse and synthesise all available data on the efficacy and safety of probiotics in people with cancer (PROSPERO registration: CRD42012003454). Randomised control trials, identified through screening multiple databases and grey literature, were included for analysing efficacy, whilst all studies were included for the analysis of safety of probiotics. Primary outcomes were the reduction in duration, severity and incidence of antibiotic-associated diarrhoea and chemotherapy-associated diarrhoea, and adverse events, especially probiotic-associated infection. Where possible, data was combined for meta-analysis by a random-effects model, assessing causes of heterogeneity, including differences in strains, dosage and patient characteristics. Results : 11 studies (N=1557 participants) were included for assessing efficacy. Results show that probiotics may reduce the severity and frequency of diarrhoea in patients with cancer and may reduce the requirement for anti-diarrhoeal medication, but more studies are needed to assess the true effect. For example, comparing probiotic use to control groups on effect on Common Toxicology Criteria ≥2 grade diarrhoea, odds ratio=0.32 (95% confidence interval of 0.13 to 0.79; P=0.01). 17 studies (N=1530) were included in the safety analysis. 5 case reports showed probiotic-related bacteraemia/fungaemia/positive blood cultures. Conclusions : Probiotics may be a rare cause of sepsis. Further evidence needs to be collated to determine if probiotics provide a significant overall benefit for people with cancer.