P366 Escherichia coli Nissle 1917 in ulcerative colitis treatment: systematic review and meta-analysis
G. Losurdo*, A. Iannone, A. Contaldo, E. Ierardi, A. Di Leo, M. Principi
University of Bari, DETO, Bari, Italy
Escherichia coli Nissle 1917 (EcN) has been advised as a therapeutic tool for ulcerative colitis (UC) treatment. However, to date, no meta-analysis has been performed on the topic.
We performed a literature search on PubMed, MEDLINE, Science Direct and EMBASE. We evaluated success rates for induction of remission, relapse rates and side effects, expressed as Intention-to-Treat. Odd ratios (OR), pooled OR and 95% confidence intervals (CI) were calculated, based on the Mantel–Haenszel method. Heterogeneity was assessed by using the χ2 and I2 statistics and, if present, a random-effects model was adopted.
We selected 6 eligible trials, with 719 patients, 390 assigned to the study group and 329 to the control group. EcN induced remission in 61.6% of cases, whereas in the control group (mesalazine) the remission was achieved in 69.5% of cases, with a mean difference of 7.9%. The pooled OR was 0.92 (95% CI 0.15–9.66, p = 0.93). A single study showed a better performance of EcN than placebo. A relapse of the disease occurred in 36.8% in EcN group and in 36.1% in control group (mesalazine), with a mean difference of 0.8%, OR = 1.07, with a 95% CI of 0.70–1.64 (p = 0.74). Side effects were comparable (OR = 1.44, 95% CI 0.80–2.59, p = 0.22).
EcN is equivalent to mesalazine in preventing disease relapse, thus confirming current guidelines recommendations. EcN seems to be as effective as controls in inducing the remission; therefore, its use cannot be recommended as in one study the comparison was performed against placebo despite further studies may be helpful for this topic.