Next-Gen biotherapeutics: A systematic review and network meta-analysis on postbiotics as treatment for pediatric...

Due to the recency of the postbiotic field, no head-to-head postbiotic studies have investigated its biotherapeutic potential for atopic dermatitis (AD). No network meta-analysis (NMA) has been conducted to synthesize relevant studies comparing postbiotic interventions for AD.

To assess the comparative efficacy and safety of postbiotic strains in the treatment of pediatric AD.

This was an NMA of randomized controlled studies that evaluated postbiotics in treating pediatric AD. Systematic search of databases and registers from inception to November 30, 2022. Three authors independently performed the search, screening, and appraisal using the Cochrane risk-of-bias tool version 2 and data extraction. Data analysis was performed using STATA14 software.

Nine studies evaluated eight postbiotic preparations. Lactobacillus rhamnosus IDCC 3201 (LR) ranked highest in the efficacy outcome. Compared to placebo, LR may be effective in reducing symptoms of atopic dermatitis in the main analysis (SMD -0.53, 95%CI -1.02 to -0.04) and sensitivity analysis involving studies that used SCORAD (MD -5.52, 95% CI -10.46 to -0.58), based on low-certainty evidence. Based on moderate-certainty evidence, LR probably did not increase the risk of adverse events (RR 0.97, 95% CI 0.79, 1.21). Although Lactobacillus paracasei GM080 (LP2) ranked highest in the safety outcome, it may not reduce AD symptoms compared to placebo (SMD -0.03, 95% CI -0.37, 0.32) based on low-certainty evidence.

LR showed significant benefits in children with AD based on low-certainty evidence. Further investigation of LR is recommended.