ACG Research Supports Efficacy of FMT for IBD

Murtaza Hussain, MD

The continued use of fecal microbiota transplantation (FMT) to treat patients with inflammatory bowel disease (IBD) is supported by ongoing research.

A team, led by Murtaza Hussain, MD, Hurley Medical Center, Michigan State University, conducted an updated systematic review and meta-analysis to provide a more robust understanding of the efficacy and safety of FMT on patients with active IBD compared to placebo.

FMT

Fecal microbiota transplantation is a relatively new treatment that involves taking feces from healthy donors to rebuild the gut microbiota of a diseased individual. FMT is delivered through upper or lower endoscopy via enemas or capsules.

In recent years, FMT has emerged as an effective treatment for recurrent C difficile infections, with cure rates of 82-88%. In fact, FMT has shown more efficacy than the antibiotics commonly used to treat the infections.

FMT is considered a top treatment for recurrent CDI with evidence suggesting human metabolic profiles could be influenced by the treatment.

In past studies, FMT has shown efficacy in treating patients with active IBD.

ACG Data

In the study, presented during the 2022 American College of Gastroenterology (ACG) Annual Meeting in Charlotte, the investigators reviewed multiple databases for randomized controlled trials concerning patients with active IBD treated with FMT compared to placebo.

Overall, they identified 10 trials with the desired study outcomes involving 437 patients that met a baseline severity of ulcerative colitis or Crohn’s disease based on the Mayo Score and Harvey Bradshaw Index.

They also standardized improvement by the same scales.

FMT for IBD

The study results are consistent with previous meta-analyses that show the efficacy of FMT in patients with IBD compared to placebo, where clinical (OR, 1.506; 95% CI, 1.259-1.803), P <0.0001), endoscopic (OR, 2.335; 95% CI, 1.577-3.457, P <0.0001), and histologic (OR, 3.764; 95% CI, 1.986-7.136; P <0.001) remission were consistent with previous results.

For safety, adverse events (OR, 0.745; 95% CII, 0.537-1.033; P = 0.077) in patients treated with FMT were also as expected.

“FMT continues to demonstrate superior efficacy when compared to placebo in terms of active IBD treatment,” the authors wrote. “Likewise, its adverse events compared to placebo display no statistical significance, equating to an analogous safety profile. Larger RCTs with longer follow up and more CD patients are necessary to strengthen the validity of FMT as an IBD therapeutic modality.”

The study, “A0346 - Efficacy and Safety of Fecal Microbiota Transplantation in the Treatment of Active Inflammatory Bowel Disease - An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials,” was published online by ACG.