The following is a summary of “A Randomized Cross-Over Trial of Prebiotics and Probiotics in Multiple Sclerosis: Trial Feasibility, Supplement Tolerability and Symptom Abatement,” published in the July 2024 issue of Neurology by Farber et al.

Researchers started a retrospective study to investigate the effects of prebiotics on the gut microbiome and immune function in pwMS, compared to the established use of probiotics.

They conducted a randomized, open-label trial involving participants with relapsing-remitting MS undergoing B-cell depletion therapy at two MS centers. Initially, 22 participants entered a crossover study where they received either probiotic (Visbiome, containing Lactobacillus, Bifidobacterium, and Streptococcus species) or prebiotic (Prebiotin, containing oligofructose enriched inulin) supplementation for 6 weeks, followed by a washout period. Later, due to pandemic disruptions and probiotic supply depletion, another 15 participants joined a single-arm study receiving prebiotic supplementation for 6 weeks, followed by a washout period. The study evaluated supplement tolerability and PROs related to MS (disability, fatigue, mood, and bowel symptoms) before and after each supplement phase and washout period. Plasma, serum, peripheral blood mononuclear cells, and stool samples were bio-archived at each time point for future multi-omic analysis.

The results showed that prebiotics (Prebiotin, containing oligofructose enriched inulin) and probiotics (Visbiome, containing Lactobacillus, Bifidobacterium, and Streptococcus species) had comparable adherence rates (around 80%) and were well-tolerated in pwMS. Participants using either supplement reported minor adverse events, primarily mild and self-limited—a subjective preference for prebiotics over probiotics. When comparing changes in PRO scores from baseline to 6 weeks post-supplementation, significant differences were observed between prebiotics and probiotics regarding the change in patient-reported global symptom burden (MSRS-R Total) and bowel control (BWCS). Specifically, probiotics statistically improved bowel control from baseline to post-supplementation.

Investigators found prebiotics and probiotics to be generally well-tolerated, warranting further investigation into their impact on MS through future trials and biological data analysis.

Source: msard-journal.com/article/S2211-0348(24)00339-0/abstract#%20