Next-Gen Biotherapeutics: A Systematic Review and Network Meta-Analysis on Postbiotics as Treatment For Pediatric Atopic Dermatitis

Background: Due to the recency of the postbiotic field, there are no head-to-head postbiotic studies investigating its biotherapeutic potential for atopic dermatitis (AD). No network meta-analysis (NMA) has yet been conducted to synthesize relevant studies to compare postbiotic interventions for AD. Objective: To assess the comparative efficacy and safety of postbiotic strains for treating pediatric AD. Method: ology: This is an NMA of randomized controlled studies that evaluate postbiotics in treating pediatric AD. Systematic search of databases and registers from inception to November 30, 2022. Three authors independently performed the search, screening, appraisal using the Cochrane risk of bias tool version 2 and data extraction. Data analysis was done using STATA14 software. Results: : There were 9 studies that evaluated 8 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 both 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 does not increase the risk of adverse events (RR 0.97, 95% CI 0.79 to 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 to 0.32) based on low-certainty evidence. Conclusion: LR showed significant benefits for children with AD, based on low-certainty evidence. Further investigation on LR is recommended.