Fecal Microbiota Transplantation (FMT) with Colonoscopy Is Superior to Enema and Nasogastric Tube While Comparable to Capsule for the Treatment of Recurrent Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

Ramai, Daryl; Zakhia, Karl; Fields, Paul J.; Ofosu, Andrew; Patel, Goonja; Shahnazarian, Vahe; Lai, Jonathan; Dhaliwal, Amaninder; Reddy, Madhavi; Chang, Shannon

doi:10.1007/s10620-020-06185-7

Cited by 65 publications

(60 citation statements)

References 36 publications

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“…The clinical effect of FMT varied according to the delivery method and the number of administrations. In contrast to previous reviews [ 14 – 16 ], the current review demonstrates that lower GI endoscopy is superior to all other delivery modalities and not only enema or upper administration. This underpins lower GI endoscopy as the gold standard despite the absolute gain of effect relative to the other delivery methods following repeat FMT is minimal.…”

Section: Discussioncontrasting

confidence: 76%

“…Previous systematic reviews [ 11 – 16 ] demonstrated similar high effect rates for FMT but did not include both observational and controlled studies. By including both, this review is the first to establish the quality of evidence for several important clinical determinants needed to consolidate FMT as an evidence-based treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Previous systematic reviews [ [11] , [12] – 17 ] have confirmed the high clinical effect of FMT for recurrent CDI and indicated that the treatment effect may depend on the method of delivery and treatment regimens [ 15 , 16 ]. Still, no clear clinical evidence exists for the cumulative effect of FMT following single or repeated treatment regimens, and the quality of evidence for FMT compared with standard antibiotics has been rated as moderate in previous systematic reviews and guidelines due to inconsistencies [ 10 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Faecal microbiota transplantation for recurrent Clostridioides difficile infection: An updated systematic review and meta-analysis

et al. 2020

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Background: Faecal microbiota transplantation (FMT) is effective for recurrent Clostridioides difficile infection (CDI), but inconsistent effect rates and uncertain evidence levels have warranted caution. To clarify, we aimed to establish the evidence of FMT for recurrent CDI, updated across different delivery methods, treatment regimens, and in comparison with standard antibiotics. Methods: In this updated systematic review and meta-analysis, we searched PubMed, Scopus, Embase, Web of Science, Clinical Key, and Svemed+ for FMT literature published in English until November 11, 2019. We included observational and clinical trials with or without antibiotic comparators and excluded studies with below 8 weeks follow-up and fewer than 15 patients. The primary outcome was clinical outcome by week 8. We comprehensively extracted patient and procedural data. In a random-effects meta-analysis, we estimated the clinical effect for repeat or single FMT, different delivery methods, and versus antibiotics. We rated the evidence according to the Cochrane and GRADE methods. The PROSPERO preregistration number is CRD42020158112. Findings: Of 1816 studies assessed, 45 studies were included. The overall clinical effect week 8 following repeat FMT (24 studies, 1855 patients) was 91% (95% CI: 89À94%, I 2 =53%) and 84% (80À88%, I 2 =86%) following single FMT (43 studies, 2937 patients). Delivery by lower gastrointestinal endoscopy was superior to all other delivery methods, and repeat FMT significantly increased the treatment effect week 8 (P<0¢001). Compared with vancomycin, the number needed to treat (NNT) for repeat FMT was 1¢5 (1¢3À1¢9, P<0¢001) and 2.9 (1¢5À37¢1, P=0¢03) for single FMT. Repeat FMT had high quality of evidence. Interpretation: High-quality evidence supports FMT is effective for recurrent CDI, but its effect varies with the delivery method and the number of administrations. The superior NNT for FMT compared with antibiotics suggests that patients may benefit from advancing FMT to all instances of recurrent CDI. Funding: Innovation Fund Denmark (j.no. 8056-00006B).

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Faecal microbiota transplantation for recurrent Clostridioides difficile infection: An updated systematic review and meta-analysis

et al. 2020

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“…In addition, previous data suggest that adverse drug reactions attributed to conventional FMT are rare, if donor screening and FMT application are carried out correctly. Reported rates of minor and usually transient reactions are below 10% and usually affect the gastrointestinal tract [9][10][11][12] . Serious adverse drug reactions have mostly been observed as a consequence of incomplete donor screening [13] or as a complication related to the endoscopy procedure and not to FMT material.…”

Section: Discussionmentioning

confidence: 99%

Clinical effectiveness of bidirectional fecal microbiota transfer in the treatment of recurrent Clostridioides difficile infections

Bestfater

Vehreschild

Stallmach

et al. 2021

Digestive and Liver Disease

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Background: Fecal microbiota transfer (FMT) has become a standard of care in the prevention of multiple recurrent Clostridioides difficile (rCDI) infection. Aim: While primary cure rates range from 70-80% following a single treatment using monodirectional approaches, cure rates of combination treatment remain largely unknown. Methods: In a retrospective case-control study, outcomes following simultaneous bidirectional FMT (bFMT) with combined endoscopic application into the upper and lower gastrointestinal tract, compared to standard routes of application (endoscopy via upper or lower gastrointestinal tract and oral capsules; abbreviated UGIT, LGIT and CAP) on day 30 and 90 after FMT were assessed. Statistical matching partners were identified using number of recurrences (< 3; ≥3), age and gender. Results: Primary cure rates at D30 and D90 for bFMT were 100% (p = .001). The matched control groups showed cure rates of 81.3% for LGIT (p = .010), 62.5% for UGIT (p = .0 0 0) and 78.1% for CAP (p = .005) on D30 and 81.3% for LGIT (p = .010), 59.4% for UGIT (p = .0 0 0) and 71.9% for CAP (p = .001) on D90. Conclusion: In our analysis, bFMT on the same day significantly increased primary cure rate at D30 and D90. These data require prospective confirmation but suggest that route of application may play a significant role in optimizing patient outcomes. ClinicalTrials.gov no: NCT026 8106 8

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“…In a study by Ramai et al (2020) comparing various routes of administration of fecal transplantation between colonoscopic, nasogastric, capsule and enema in the treatment of recurrent C. difficile infection, there was a greater cure rate with colonoscopic (94.8%) administration and capsular (92.1%) compared to nasogastric (78.1%) and enema (87.2%). Although capsular administration was comparable in cure rate to colonoscopic administration, the use of capsules in this study had a smaller sample size when compared to colonoscopic (Ramai et al, 2020). Another example of the use of colonoscopic fecal transplantation is seen in a study measuring the efficacy of FMT in the treatment of Crohn's disease in which donor recipients received a single-dose fecal transplant.…”

Section: Fmt Proceduresmentioning

confidence: 99%

Microbiota Transplant in the Treatment of Obesity and Diabetes: Current and Future Perspectives

Napolitano

Covașă

2020

Front. Microbiol.

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A wealth of evidence has revealed the critical role of the gut microbiota in health and disease. Many chronic diseases have been associated with gut microbiota imbalance in its composition, diversity and functional capacity. Several types of interventions have been shown to correct microbiota imbalance and restore the beneficial metabolic outcomes of a normal microbiota. Among them, fecal microbiota transplantation (FMT) is an emergent, promising technology employed to improve clinical outcomes of various pathological conditions through modifications in the gut microbiota composition. FMT has been used successfully as a treatment option in recurrent Clostridium difficile infection , a condition characterized by severe gut microbiota dysbiosis. However, the potential usage of FMT in other microbiota-associated conditions different from C. difficile such as metabolic syndrome or obesity that are also marked by gut dysbiosis is still under investigation. Furthermore, the contribution of the gut microbiota as a cause or consequence in metabolic disease is still largely debated. This review provides critical information on the methodological approaches of FMT and its technological innovation in clinical applications. This review sheds light on the current findings and gaps in our understanding of how FMT can be used as a future biotherapeutic to restore microbial homeostasis in amelioration of obesity and diabetes.

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Fecal Microbiota Transplantation (FMT) with Colonoscopy Is Superior to Enema and Nasogastric Tube While Comparable to Capsule for the Treatment of Recurrent Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

Cited by 65 publications

References 36 publications

Faecal microbiota transplantation for recurrent Clostridioides difficile infection: An updated systematic review and meta-analysis

Faecal microbiota transplantation for recurrent Clostridioides difficile infection: An updated systematic review and meta-analysis

Clinical effectiveness of bidirectional fecal microbiota transfer in the treatment of recurrent Clostridioides difficile infections

Microbiota Transplant in the Treatment of Obesity and Diabetes: Current and Future Perspectives

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