NEH Chehade et al. Inflamm Bowel Dis 2023; 29: 808-817. Efficacy of Fecal Microbiota Transplantation in the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials
HS Almomen, B Al-Bawardy. Inflamm Bowel Dis 2023; 29: 837-838. Oral Vancomycin Induced and Maintained Clinical and Endoscopic Remission in Ulcerative Colitis and Primary Sclerosing Cholangitis Post-liver Transplantation
In the first study by Chehade et al, the authors analyzed six RCTs involving 324 patients. Key findings:
- Compared with placebo, FMT has significant benefit in inducing combined clinical and endoscopic remission (odds ratio, 4.11; 95% confidence interval, 2.19-7.72; P < .0001)
- clinical remission with FMT was 46.2% compared 22.5% for placebo
- clinical response with FMT was 51.6% compared to 30.1% for placebo
- endoscopic remission with FMT was 18.9% compared to 6.1% for placebo
- endoscopic response with FMT was 36.7% compared to 22.4% for placebo
Discussion Points:
- “The studies included in our article indicate that there is a shift in the microbiota composition of responders in the FMT group to resemble the profile of healthy donors”
- FMT delivery via upper GI tract was equally effective as delivery via lower GI tract in these studies in inducing combined remission
- “The understanding of FMT effectiveness for IBD is in its infancy.”
In the case report by Alomomen et al, a 34 year old with refractory ulcerative colitis and PSC (post-transplant) had not responded to infliximab, vedolizumab, adalimumab, tofacitinib or 10 months of ustekinumab (every 4 weeks). In addition, he was receiving tacrolimus therapy due to his liver transplant. His colonoscopy demonstrated a continuous Mayo 3 colitis. Subsequently, vancomycin therapy was added to his treatment (500 mg BID); he continued ustekimumab. Six months afterwards, his fecal calprotectin had dropped to 277 from 1600 and his CRP and hemoglobin had normalized. Repeat colonoscopy demonstrated complete endoscopic healing.
My take: There are many patients who do not respond to current IBD therapies. These two studies show that both FMT and vancomycin could be useful in selected patients.
Related blog posts:
- Treatments for “Bad” Inflammatory Bowel Disease (Part 1) (2023)
- Treatments for “Bad” Inflammatory Bowel Disease (Part 2) & Reassuring Data on Tofacitinib
- Treatments for “Bad” Inflammatory Bowel Disease (Part 3)
- Fecal Microbial Transplantation -Evidence for Use Beyond Recurrent Clostridium Difficile | gutsandgrowth
- FDA Approves Pharmaceutical Fecal Transplant Product
- Oral Antibiotics For Refractory Inflammatory Bowel Disease
- Vancomycin for Chronic Pouchitis & ASPEN Infant Formula Resources
Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.
gutsandgrowth 