Fecal transplant for UC: stool source matters

  • Costello SP & al.
  • JAMA
  • 15 Jan 2019

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Anaerobically prepared pooled donor fecal microbiota transplantation (FMT) recipients in patients with mild to moderately active ulcerative colitis (UC) had 5-fold better odds of steroid-free remission at 8 weeks than recipients of autologous FMT.

Why this matters

  • Anaerobically prepared donor FMT may be an effective treatment option for UC, but more research is needed for longer-term efficacy and safety.

Study design

  • Randomized, double-blind controlled clinical trial of 73 adults at 3 Australian centers comparing anaerobically prepared donor FMT (n=38) with autologous FMT (n=35) by colonoscopy followed by 2 enemas during a 7-day period.
  • Primary outcome was steroid-free remission by total Mayo score of ≤2 with an endoscopic Mayo score of ≤1 at week 8 (Mayo scores range from 0 to 12, with 12 being most severe).
  • Funding: National Health and Medical Research Council; Gutsy Foundation.

Key results

  • The primary outcome at 8 weeks was attained by 32% of the donor FMT group vs 9% of the autologous FMT group (difference, 23%; OR, 5.0; P=.03).
  • At 12 months, remission was maintained by 42% of the donor FMT recipients who achieved the primary outcome.
  • The donor FMT group had 3 serious adverse events; the autologous FMT group had 2.

Limitations

  • Small sample sizes.
  • Short follow-up.

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