St. Joseph's University Medical Center Paterson, NJ
Mohammad Bdair, 1, Khadeeja Ali Hamzah, 2, Islam Rajab, MD3, Abdalhakim Shubietah, MD4, Zaid Sawaftah, 1, Anwar Zahran, 1, Abdallah Hussein, MD5, Fathi Milhem, MD6, Orabi Hajjeh, 1, Yousif Hameed Kurmasha, 7, Abdelfattah M. Dahmas, 8, Maram M. Abukhalil, 1, Omar Abu-Khazneh, MD1, Kashyap Chauhan, 3, Walid Baddoura, MD3 1Department of Medicine, An-Najah National University, Nablus, Palestine., Nablus, Palestinian Territories; 2Baghdad University AIkindy College of Medicine , Baghdad , Iraq, Baghdad, Baghdad, Iraq; 3St. Joseph's University Medical Center, Paterson, NJ; 4Advocate Illinois Masonic Medical Center, Chicago, IL; 5Virtua Our Lady of Lourdes Hospital, Camden, NJ; 6Department of Medicine, An-Najah National University, Nablus, Palestine., Tulkarem, Palestinian Territories; 7College of Medicine, University of Kufa, Najaf, An Najaf, Iraq; 8Department of Medicine, An-Najah National University, Nablus, Palestine., Tulkarm, Palestinian Territories Introduction: Multiple sclerosis (MS), particularly the relapsing-remitting subtype (RRMS), is influenced by complex interactions involving immune dysregulation, neuroinflammation, oxidative stress, and metabolic disturbances. Emerging evidence suggests that probiotic supplementation may help modulate these pathways, offering potential therapeutic value beyond conventional immunomodulatory treatments. This meta-analysis aims to assess the efficacy and safety of oral probiotics compared to placebo in improving neurological disability, mood symptoms, oxidative stress markers, and metabolic parameters in adults with RRMS. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing probiotics to placebo in adults with RRMS was conducted. Searches were performed in PubMed, Cochrane CENTRAL, Web of Science, Embase, and Scopus through November 12, 2024. Primary outcomes included Expanded Disability Status Scale (EDSS) and mental health indices (BDI-II, DASS, GHQ-28). Secondary outcomes included inflammatory (TNF-α, IL-6), oxidative (nitric oxide, MDA, TAC), and metabolic markers (fasting insulin, HOMA-IR, QUICKI). Standardized mean differences (SMD) or mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models. Statistical analysis was performed using Review Manager (RevMan) version 5.4. Results: Five randomized controlled trials comprising 288 patients were included, with 144 patients receiving probiotics and 144 receiving placebo, over a treatment duration of 12 to 24 weeks. Probiotics significantly reduced EDSS (SMD = –6.52; 95% CI: –12.96 to –0.08; p = 0.05), BDI-II (SMD = –3.72; p < 0.001), and DASS (SMD = –3.75; p < 0.001). Nitric oxide levels increased (SMD = 8.20; p = 0.01). Improvements in insulin sensitivity were observed (fasting insulin: SMD = –4.45; p = 0.005; HOMA-IR: SMD = –3.59; p < 0.001; QUICKI: SMD = 3.67; p = 0.003). TNF-α levels decreased (SMD = –1.05; p < 0.001), and GHQ-28 scores improved modestly (MD = –2.63; p = 0.04). No significant effects were noted for hs-CRP, IL-6, MDA, or TAC. Discussion: Probiotics may improve neurological disability, mood, nitric oxide levels, and insulin sensitivity in RRMS while maintaining safety. Despite high heterogeneity in some outcomes, findings support probiotics as a potential adjunctive strategy. Larger, multicenter trials with standardized formulations are warranted.
Figure: Figure 1: Forest plots showing the effects of probiotics versus placebo on (A) GHQ score, (B) BDI total score, (C) DASS score, and (D) EDSS in patients with RRMS.
Disclosures: Mohammad Bdair indicated no relevant financial relationships. Khadeeja Ali Hamzah indicated no relevant financial relationships. Islam Rajab indicated no relevant financial relationships. Abdalhakim Shubietah indicated no relevant financial relationships. Zaid Sawaftah indicated no relevant financial relationships. Anwar Zahran indicated no relevant financial relationships. Abdallah Hussein indicated no relevant financial relationships. Fathi Milhem indicated no relevant financial relationships. Orabi Hajjeh indicated no relevant financial relationships. Yousif Hameed Kurmasha indicated no relevant financial relationships. Abdelfattah M. Dahmas indicated no relevant financial relationships. Maram M. Abukhalil indicated no relevant financial relationships. Omar Abu-Khazneh indicated no relevant financial relationships. Kashyap Chauhan indicated no relevant financial relationships. Walid Baddoura indicated no relevant financial relationships.
Mohammad Bdair, 1, Khadeeja Ali Hamzah, 2, Islam Rajab, MD3, Abdalhakim Shubietah, MD4, Zaid Sawaftah, 1, Anwar Zahran, 1, Abdallah Hussein, MD5, Fathi Milhem, MD6, Orabi Hajjeh, 1, Yousif Hameed Kurmasha, 7, Abdelfattah M. Dahmas, 8, Maram M. Abukhalil, 1, Omar Abu-Khazneh, MD1, Kashyap Chauhan, 3, Walid Baddoura, MD3. P5572 - Impact of Probiotic Supplementation on Neurological and Metabolic Outcomes in Relapsing Remitting Multiple Sclerosis: A Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
