Recommendations to Improve Quality of Probiotic Systematic Reviews With Meta-Analyses

Abstract

ImportanceSystematic reviews and meta-analyses often report conflicting results when assessing evidence for probiotic efficacy, partially because of the lack of understanding of the unique features of probiotic trials. As a consequence, clinical decisions on the use of probiotics have been confusing.ObjectiveTo provide recommendations to improve the quality and consistency of systematic reviews with meta-analyses on probiotics, so evidence-based clinical decisions can be made with more clarity.Evidence ReviewFor this consensus statement, an updated literature review was conducted (January 1, 2020, to June 30, 2022) to supplement a previously published 2018 literature search to identify areas where probiotic systematic reviews with meta-analyses might be improved. An expert panel of 21 scientists and physicians with experience on writing and reviewing probiotic reviews and meta-analyses was convened and used a modified Delphi method to develop recommendations for future probiotic reviews.FindingsA total of 206 systematic reviews with meta-analysis components on probiotics were screened and representative examples discussed to determine areas for improvement. The expert panel initially identified 36 items that were inconsistently reported or were considered important to consider in probiotic meta-analyses. Of these, a consensus was reached for 9 recommendations to improve the quality of future probiotic meta-analyses.Conclusions and RelevanceIn this study, the expert panel reached a consensus on 9 recommendations that should promote improved reporting of probiotic systematic reviews with meta-analyses and, thereby, assist in clinical decisions regarding the use of probiotics.

Probiotics’ Effects in the Treatment of Anxiety and Depression: A Comprehensive Review of 2014–2023 Clinical Trials

“…In addition, as they are nutritional supplements, probiotics could help alleviate the social stigma faced by people taking psychotropic medication. Despite advances in understanding their mechanisms of action and effectiveness, a knowledge gap still exists on where and how best to use them [ 41 ]. For instance, whether probiotics can be used as a complementary treatment combined with antidepressants or as a primary treatment for depression warrants further investigation, to evaluate their efficacy regardless of other medications.…”

“…As there is still no clear evidence on which bacteria specifically contribute to the relief of depressive symptoms, future research should investigate different combinations of probiotics, as well as symbiotic and prebiotic effects alone, as their mechanisms of action might be different. Finally, from a methodological standpoint, given the challenges in analyzing highly heterogenous probiotic-related factors, such as interventions, populations, and outcome measures, future researchers should consider adhering to expert consensus methodological recommendations (e.g., on primary/secondary outcomes, definition of probiotic interventions, safety) [ 41 ].…”

“…Therefore, despite the vast scale of research that has been taking place in the multibillion dollar probiotic industry [ 18 ] in the last years there is a lack of consensus of the existing evidence on how to best use them in mental health, which might cause confusion in healthcare professionals [ 41 ]. Thus, and given the increasingly broader range of probiotic products used [ 41 ] and the rapidly increasing literature in the probiotic field [ 42 ], the aim of our study was to provide a comprehensive update of the last decade research data on the effectiveness of probiotics in the treatment of anxiety and depression.…”

“…Therefore, despite the vast scale of research that has been taking place in the multibillion dollar probiotic industry [ 18 ] in the last years there is a lack of consensus of the existing evidence on how to best use them in mental health, which might cause confusion in healthcare professionals [ 41 ]. Thus, and given the increasingly broader range of probiotic products used [ 41 ] and the rapidly increasing literature in the probiotic field [ 42 ], the aim of our study was to provide a comprehensive update of the last decade research data on the effectiveness of probiotics in the treatment of anxiety and depression. Taking into consideration the huge potential of probiotics to become novel, personalized treatments for mental health disorders, the academic importance of our study lies in the effort to analyze the most recent (last ten years) accumulated knowledge in the field and shed more light on the question of whether and to what degree probiotics are actually effective in depression and anxiety treatment.…”