Effectiveness of Saccharomyces boulardii CNCM I-745 in Adult Indian Patients with Diarrhoea: A Real-world, Multicentre, Retrospective, Comparative Study

Bhaskar Bikash Pal1, Rupali Vinodchandra Bandagi2, Kranthi Kiran Pebbili2, Rahul Rathod2, Bhavesh Kotak2, Gauri Dhanaki2, Snehal Shah3
1Peerless Hospital, Kolkata, India
2Department of Medical Affairs, Dr. Reddy’s Laboratories Ltd, Hyderabad, India
3Department of Clinical Insights, Healthplix Technologies, Bangalore, India

Tóm tắt

Multiple clinical studies have described the benefits of probiotic Saccharomyces boulardii (S. boulardii) CNCM I-745 against diarrhoea, but the real-world evidence supporting its use is lacking. To evaluate effectiveness of the S. boulardii CNCM I-745 group in a real-world setting. This was an electronic medical record (EMR)-based, retrospective, multicentre, comparative study in Indian adult patients presenting with diarrhoea managed between January 2020 and January 2022. Data of patients at the baseline visit, with a follow-up visit within 15 days, and who were administered S. boulardii CNCM I-745 (for the test group) or any other treatment modality excluding probiotics (for the control group) were considered. Effectiveness was evaluated on the basis of number of patients who did not complain of diarrhoea at follow-up. Of 30,385 adult patients with diarrhoea, 270 patients prescribed S. boulardii CNCM I-745 were included, while the control group comprised 1457 patients. The baseline median age of the test group was 47 years (range 19–86 years), while it was 44 years (range 19–100 years) for the control group. The majority of patients in both study groups were females (56.7% in the test and 51.5% in the control group). Median duration between visits was 5 days (range 1–15 days) in both study groups. In all, 77.8% patients (95% CI 72.34–82.59) in the test group did not complain of diarrhoea at follow-up, while the proportion was 15.8% (95% CI 13.95–17.76) in the control group (p < 0.05). Odds ratio (OR) for absence of diarrhoea in the S. boulardii CNCM I-745 group versus the control group was 18.7 (95% CI 13.6–25.7, p < 0.05). For subgroups on concomitant antibiotics, a significant advantage was noted again for the test versus the control group (76.8% versus 18.4%; p < 0.05; OR: 14.7 with 95% CI 8.8–24.4; p < 0.05). The effect of S. boulardii CNCM I-745 probiotic in controlling diarrhoea was better than anti-diarrhoeal and/or oral rehydration therapy in real-world clinical practice. The effect was similar even with concomitant antibiotic usage.

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Tài liệu tham khảo

World Health Organization Diarrhoeal disease. https://www.who.int/en/news-room/fact-sheets/detail/diarrhoeal-disease. Behera DK, Mishra S. The burden of diarrhea, etiologies, and risk factors in India from 1990 to 2019: evidence from the global burden of disease study. BMC Public Health. 2022;22:92. https://doi.org/10.1186/s12889-022-12515-3). Philip NA, Ahmed N, Pitchumoni CS. Spectrum of drug-induced chronic diarrhea. J Clin Gastroenterol. 2017. https://doi.org/10.1097/mcg.0000000000000752. Nilima, Kamath A, Shetty K, Unnikrishnan B, Kaushik S, Rai SN. Prevalence, patterns, and predictors of diarrhoea: a spatial-temporal comprehensive evaluation in India. BMC Public Health. 2018. https://doi.org/10.1186/s12889-018-6213-z. Srivastava S, Banerjee S, Debbarma S, Kumar P, Sinha D. Rural-urban differentials in the prevalence of diarrhoea among older adults in India: evidence from longitudinal ageing study in India, 2017–18. PLoS ONE. 2022. https://doi.org/10.1371/journal.pone.0265040. Joseph N, Suvarna P, Hariharan Bharadwaj S, Dhanush KS, Raeesa F, Mohamed Jasir KK, et al. Prevalence, risk factors and treatment practices in diarrhoeal diseases in south India. Environ Health Prev Med. 2016. https://doi.org/10.1007/s12199-016-0521-7. Ahs JW, Wenjing T, Lofgren J, Forsberg BC. Diarrhoeal diseases in low and middle-income countries. Open Infect Dis J. 2010. https://doi.org/10.2174/1874279301004010113. Farthing M, Salam MA, Lindberg G, Dite P, Khalif I, Salazar-Lindo E, et al. Acute diarrhoea in adults and children: a global perspective. J Clin Gastroenterol. 2013. https://doi.org/10.1097/mcg.0b013e31826df662. Ragavan PSK, Kaur A, Kumar M, Singhal V, Patel AM, Khunt A, et al. Retrospective analysis of EMR database to assess the effectiveness of Saccharomyces boulardii CNCM I-745 in children with acute diarrhoea during routine clinical practice. New Microb New Infect. 2020. https://doi.org/10.1016/j.nmni.2020.100766. Probiotics—International Scientific Association for Probiotics and Prebiotics (ISAPP) (isappscience.org). National Institutes of Health. Probiotics. Fact sheet for Healthcare Professionals. 2022. https://ods.od.nih.gov/factsheets/Probiotics-HealthProfessional/#en3. Czerucka D, Piche T, Rampal P. Review article: yeast as probiotics—Saccharomyces boulardii. Aliment Pharmacol Ther. 2007. https://doi.org/10.1111/j.1365-2036.2007.03442.x. Neut C, Mathieux S, Dubreuil LJ. Antibiotic susceptibility of probiotics strains: is it reasonable to combine probiotics with antibiotics? Méd Malad Infect. 2017. https://doi.org/10.1016/j.medmal.2017.07.001. Moré M, Swidsinski A. Saccharomyces boulardii CNCM I-745 supports regeneration of the intestinal microbiota after diarrheic dysbiosis: a review. Clin Exp Gastroenterol. 2015. https://doi.org/10.2147/ceg.s85574. Staniszewski A, Kordowska-Wiater M. Probiotic and potentially probiotic yeasts-characteristics and food application. 2021. Foods. https://doi.org/10.3390/foods10061306. McFarland LV, Evans CT, Goldstein EJC. Strain-specificity and disease-specificity of probiotic efficacy: a systematic review and meta-analysis. Front Med (Lausanne). 2018;5:124. Dinleyici E, Eren M, Ozen M, Yargic Z, Vandenplas Y. Effectiveness and safety of Saccharomyces boulardii for acute infectious diarrhoea. Exp Opin Biol Ther. 2012. https://doi.org/10.1517/14712598.2012.664129. Szajewska H, Kolodziej M. Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2015. https://doi.org/10.1111/apt.13344. Tung JM, Dolovich LR, Lee CH. Prevention of Clostridium difficile infection with Saccharomyces boulardii: a systematic review. Can J Gastroenterol. 2009. https://doi.org/10.1155/2009/915847. McFarland LV, Srinivasan R, Setty RP, Ganapathy S, Bavdekar A, Mitra M, et al. Specific probiotics for the treatment of pediatric acute gastroenteritis in India: a systematic review and meta-analysis. JPGN Rep. 2021;2(3): e079. Jones TF, McMillian MB, Scallan E, Frenzen PD, Cronquist AB, Thomas S, et al. A population-based estimate of the substantial burden of diarrhoeal disease in the United States; FoodNet, 1996–2003. Epidemiol Infect. 2007. https://doi.org/10.1017/s0950268806006765. Schiller LR, Pardi DS, Sellin JH. Chronic diarrhea: diagnosis and management. Clin Gastroenterol Hepatol. 2017. https://doi.org/10.1016/j.cgh.2016.07.028. Suvarna VR. Real world evidence (RWE)—are we (RWE) ready? Perspect Clin Res. 2018. https://doi.org/10.4103/picr.picr_36_18. Nallamothu BK, Hayward RA, Bates ER. Beyond the randomized clinical trial: the role of effectiveness studies in evaluating cardiovascular therapies. Circulation. 2008. https://doi.org/10.1161/circulationaha.107.703579. Boeckxstaens GE, Drug V, Dumitrascu D, Farmer AD, Hammer J, Hausken T, et al. Phenotyping of subjects for large scale studies on patients with IBS. Neurogastroenterol Motil. 2016. https://doi.org/10.1111/nmo.12886. Talley NJ. Irritable bowel syndrome: definition, diagnosis and epidemiology. Baillieres Best Pract Res Clin Gastroenterol. 1999. https://doi.org/10.1053/bega.1999.0033. Szajewska H, Guarino A, Hojsak I, Indrio F, Kolacek S, Orel R, et al. Working Group on Probiotics and Prebiotics of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Use of probiotics for the management of acute gastroenteritis in children: an update. J Pediatr Gastroenterol Nutr. 2020;71(2):261–9. https://www.worldgastroenterology.org/UserFiles/file/guidelines/probiotics-and-prebiotics-english-2017.pdf. Petersen C, Round JL. Defining dysbiosis and its influence on host immunity and disease. Cell Microbiol. 2014. https://doi.org/10.1111/cmi.12308. Kim YS, Ho SB. Intestinal goblet cells and mucins in health and disease: recent insights and progress. Curr Gastroenterol Rep. 2010. https://doi.org/10.1007/s11894-010-0131-2. Swidsinski A, Loening-Baucke V, Herber A. Mucosal flora in Crohn’s disease and ulcerative colitis—an overview. J Physiol Pharmacol. 2009;60:61–71. Strugala V, Dettmar PW, Pearson JP. Thickness and continuity of the adherent colonic mucus barrier in active and quiescent ulcerative colitis and Crohn’s disease. Int J Clin Pract. 2008. https://doi.org/10.1111/j.1742-1241.2007.01665.x. Musso G, Gambino R, Cassader M. Obesity, diabetes, and gut microbiota: the hygiene hypothesis expanded? Diabetes Care. 2010. https://doi.org/10.2337/dc10-0556. Fernandes J, Su W, Rahat-Rozenbloom S, Wolever TM, Comelli EM. Adiposity, gut microbiota and faecal short chain fatty acids are linked in adult humans. Nutr Diabetes. 2014. https://doi.org/10.1038/nutd.2014.23. McFarland LV. Use of probiotics to correct dysbiosis of normal micro-biota following disease or disruptive events: a systematic review. BMJ Open. 2014. https://doi.org/10.1136/bmjopen-2014-005047. Micklefield G. Saccharomyces boulardii bei Antibiotika-assoziierter Diarrhöe [Saccharomyces boulardii in the treatment and prevention of antibiotic-associated diarrhoea]. MMW-Fortschritte der Medizin Originalien. 2014;156:18–22. Pothoulakis C. Review article: anti-inflammatory mechanisms of action of Saccharomyces boulardii. Aliment Pharmacol Ther. 2009;30(8):826–33. https://doi.org/10.1111/j.1365-2036.2009.04102.x.