Fecal Microbiota Transplant for Patients With IBD and rCDI: Safety and Efficacy

Patients that are diagnosed with recurrent Clostridioides difficile infection (rCDI), have shown significant improvements when they receive a fecal microbiota transplantation (FMT). Patients with inflammatory bowel disease (IBD) could also benefit from FMT. However, FMT has not been studied for its safety and efficacy for patients with IBD. Serena Porcari, Department of Medical and Surgical Sciences, Italy, and her colleagues sought out to evaluate the safety and efficacy of FMT as a treatment for patients with rCDI and IBD.

In this analysis, Porcari and her colleagues used research from November 2022 that included patients with rCDI and IBD that received an FMT. They determined a follow-up point of 8 weeks after a transplant for the data set to find if there was any evidence of recurrence. They also contacted authors that did provide efficacy data in their studies for the analysis. Patients that received FMT without rCDI, patients with pouchitis, and animal studies were not included in this analysis.

Of the research collected, 15 met the criteria. 777 patients were included. Researchers found that the cure rates were higher for patients with rCDI and IBD. The patients with single FMT were found to be 81% effective and their patients with overall FMT were effective at 92%. Overall FMT was shown to have more of an advantage at a cure than single FMT. The researcher observed serious adverse events (AE) in 12% of the patients included. Hospitalization, IBD-related surgery, and IBD flare were the most common adverse events.

“In our meta-analysis, FMT was delivered by colonoscopy in most studies, and, when reported, at least 50–60 g of feces were used.” The authors wrote, “Both these characteristics have been associated with higher cure rates of rCDI in patients without IBD and could represent the explanation for the relatively high efficacy rates also observed in patients with IBD.”

Finally, the researchers found that FMT for patients with IBD and rCDI have high safety and efficacy evaluations. Overall, FMT also has higher efficacy rates than single FMT. Their analysis supports the use of FMT for rCDI and IBD, but further investigation is necessary to determine the efficacy levels of FMT as a treatment for solely IBD.

Reference

Porcari S, Baunwall SMD, Occhionero AS, et al. Fecal microbiota transplantation for recurrent C. difficile infection in patients with inflammatory bowel disease: A systematic review and meta-analysis. Journal of Autoimmunity. 2023;141:103036. doi:10.1016/j.jaut.2023.103036.