Department of Pharmacy, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou, Zhejiang, China.
PLoS One. 2023 Sep 21;18(9):e0291864. doi: 10.1371/journal.pone.0291864. eCollection 2023.
Probiotics have become increasingly popular among cancer patients. However, there is limited data from a real-world setting. This study aims to conduct a retrospective analysis to understand the trend of probiotic prescriptions in Chinese colorectal cancer patients. The Mann-Kendall and Cochran-Armitage trend test was applied to estimate the trend significance. Gephi software identified the combination of probiotic strains. The binary logistic regression investigated influence factors, and Spearman's rank correlation coefficient calculated correlations between probiotics and antitumor drug usage. The probiotic prescription percentage increased from 3.3% in 2015 to 4.2% in 2021 (Z = 12.77, p < 0.001). Although 48.3% of probiotic prescriptions had no indication-related diagnosis, diarrhea (OR 10.91, 95% CI 10.57-11.26) and dyspepsia (3.97, 3.82-4.12) included prescriptions most likely to contain probiotics. Prescriptions from the tertiary hospital (1.43,1.36-1.50), clinics (1.30, 1.28-1.33), and senior patients (1.018 per year, 1.017-1.019) were more likely to contain probiotics. Most probiotic prescriptions (95.0%) contained one probiotic product but multiple strains (69.3%). Enterococcus faecalis (49.7%), Lactobacillus acidophilus (39.4%), and Clostridium butyricum (27.9%) were the most prescribed strains. The probiotics co-prescribed with antitumor agents increased rapidly from 6.6% to 13.8% in seven years (Z = 15.31, p < 0.001). Oral fluorouracil agents (2.35, 2.14-2.59), regorafenib (1.70,1.27-2.26), and irinotecan (1.27,1.15-1.41) had a higher probability to co-prescribed with probiotics. There was no correlation between probiotic strain selection and specific antitumor drug use. The increasing prescription of probiotics in colorectal cancer patients in China may be related to treating the gastrointestinal toxicity of anti-cancer drugs. With unapproved indications and a lack of strain selectivity, evidence-based guidelines are urgently needed to improve probiotic use in this population.
益生菌在癌症患者中越来越受欢迎。然而，实际数据有限。本研究旨在进行回顾性分析，以了解中国结直肠癌患者益生菌处方的趋势。采用曼肯德尔和考克伦-阿密特趋势检验来估计趋势的显著性。Gephi 软件确定了益生菌菌株的组合。二元逻辑回归调查了影响因素，Spearman 秩相关系数计算了益生菌与抗肿瘤药物使用之间的相关性。益生菌处方的百分比从 2015 年的 3.3%增加到 2021 年的 4.2%（Z=12.77，p<0.001）。尽管 48.3%的益生菌处方没有与适应症相关的诊断，但腹泻（OR 10.91，95%CI 10.57-11.26）和消化不良（3.97，3.82-4.12）包含最有可能包含益生菌的处方。来自三级医院（1.43，1.36-1.50）、诊所（1.30，1.28-1.33）和老年患者（每年 1.018 岁，1.017-1.019）的处方更有可能包含益生菌。大多数益生菌处方（95.0%）包含一种益生菌产品，但含有多种菌株（69.3%）。粪肠球菌（49.7%）、嗜酸乳杆菌（39.4%）和丁酸梭菌（27.9%）是最常开的菌株。与抗肿瘤药物共同开的益生菌在七年内从 6.6%迅速增加到 13.8%（Z=15.31，p<0.001）。口服氟尿嘧啶类药物（2.35，2.14-2.59）、regorafenib（1.70，1.27-2.26）和伊立替康（1.27，1.15-1.41）与益生菌共同开的可能性更高。益生菌菌株选择与特定抗肿瘤药物使用之间没有相关性。中国结直肠癌患者益生菌处方的增加可能与治疗抗肿瘤药物的胃肠道毒性有关。由于没有批准的适应症和缺乏菌株选择性，迫切需要制定基于证据的指南来改善该人群中益生菌的使用。
