Fecal microbiota transplantation improves remission rates in ulcerative colitis

1. In this randomized controlled trial, patients who received a donor fecal microbiota transplant (FMT) had a higher rate of steroid-free remission at 8-weeks than those who a received autologous FMT.

2. Donor FMT was also associated with better clinical response and clinical remission.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Ulcerative colitis (UC) is a chronic inflammatory bowel condition that is treated with anti-inflammatory medications but often results in breakthrough symptoms, increased colorectal cancer risk, and sometimes necessitates colectomy. Though some studies have implicated colonic bacteria as being tied to UC pathogenesis, it is unclear if Fecal Microbiota Transplant (FMT) would be a suitable treatment. In this randomized controlled trial, a 3-dose, 1-week induction course of donor FMT was more likely to induce steroid-free, clinical and endoscopic remission in patients with active UC at 8 weeks versus autologous FMT. Patients who underwent donor FMT also had improved clinical remission and response.

This study utilized an anaerobic method for processing donor FMTs, which may have contributed to the similar clinical effects to other studies using higher intensity regimens. However, limitations including small study size and only 8 weeks of follow up suggest that further investigation would be necessary to endorse FMT as an effective and safe treatment for UC.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Findings From a Randomized Controlled Trial of Fecal Transplantation for Patients With Ulcerative Colitis

In-Depth [ randomized controlled trial]: 73 adults with active UC (total Mayo score of 3 to 10 points and endoscopic score >1) from 3 Australian centers with mild to moderately active UC were recruited. Stable dosing of UC maintenance therapy, 5-aminosalicylic acid, thiopurines and methotrexate, and biological agents, was required prior to therapy. Patients enrolled taking an oral dose of prednisone had a mandatory taper. At colonoscopy, 200mL of fecal suspension of either donor stool or autologous stool was delivered into the right colon. Patients who received donor FMT had greater steroid free remission rates at 8-weeks than those who received autologous FMT (Odds Ratio 5.0; CI₉₅ 1.2 to 20.1). The mean total Mayo score decreased in both groups at 8 weeks but was significantly greater in the donor FMT group: (autologous FMT -1.2; CI₉₅ -1.9 to -0.5; donor FMT -3.5; CI₉₅ -4.3 to -2.7). Clinical response, measured by a ≥3 point Mayo score reduction at 8 week and 12 months was observed more often in participants receiving donor FMT (55%) vs. autologous FMT (23%) (difference 32%; CI₉₅ 10% to 54%). Clinical remission as measured by a Simple Clinical Colitis Activity index score ≤2 at 8 weeks and 12 months was also observed often in participants receiving donor FMT (difference 30%; CI₉₅ 7% to 51%).

Image: PD

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