EPP095
The effect of prebiotics on the gut microbiota in patients treated with atypical antipsychotics: a pilot study
E. J. Giltay 1,*, N. J. de Bles 1, N. Rius-Ottenheim 1, J. P. Bogers 2
1Psychiatry, Leiden University Medical Center (LUMC), Leiden, 2Intensive Care Clinics, Mental Health Organization (GGZ) Rivierduinen, Oegstgeest, Netherlands
Introduction: Atypical antipsychotic (AAP) drugs are prescribed to patients with psychotic and other mental disorders. A common adverse effect is metabolic syndrome (MetS), often via weight gain and dyslipidemia. Besides lifestyle factors, drug-induced gut dysbiosis has been proposed as a mechanism. Dysbiosis is often marked by reduced Bifidobacterium, yet its causal role in MetS remains unclear.
Objectives: Our aim was to evaluate the relative change in the proportion of bifidobacteria within the total fecal bacterial community, with the hypothesis that supplementation would lead to an increase.
Methods: We included psychiatric patients with BMI > 25 kg/m², using long-term atypical antipsychotics in a pilot study. Following a 4-week run-in period, participants received a daily dose of the prebiotic combination of galacto-oligosaccharides (GOS) and 2’-fucosyllactose (2’-FL) (7.0 g Biotis® GOS + 0.7 g 2’-FL) for 6 weeks, with a washout of 4 weeks thereafter. The primary outcome was change in fecal bifidobacteria. Secondary outcomes included mental health (e.g., EQ-5D utility score) and metabolic syndrome measures. Fecal microbiome composition was assessed by 16S rRNA gene sequencing of the V4 region on the Illumina NovaSeq6000 platform.
Results: Twenty-one participants using AAP (clozapine; n=9) were included (mean age 43.4 years; 67% male); of whom 76% had a psychotic disorder. Gut microbiome composition shifted from baseline to week 4, with stability thereafter. Faecalibacterium increased significantly (p=0.03) during supplementation, while diversity indices remained unchanged. Bifidobacterium increased non-significantly (p=0.10) during supplementation, but the overall increase from baseline to week 10 was statistically significant (change = 0.098; SE = 0.030; p = 0.002). This may be explained by the possibility that some participants may have unintentionally started their prebiotics already during the run-in phase. No serious adverse events occurred. Metabolic assessments (BMI, WHR, RR) did not change during supplementation. Subjective scales showed slight favorable changes, but none reached statistical significance, except for the EQ-5D utility score (QoL), which improved significantly (p = 0.01).
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Conclusions: Prebiotic supplementation was well tolerated and associated with some favorable shifts in gut microbiota, supporting its potential as an adjunctive strategy to mitigate antipsychotic-associated dysbiosis.
Disclosure of Interest: E. Giltay Grant / Research support from: The Study was funded by a grant from FrieslandCampina, N. de Bles: None Declared, N. Rius-Ottenheim: None Declared, J. Bogers: None Declared