P594 Predictors of non-response to repeated faecal microbiota transplantation in patients with therapy refractory ulcerative colitis

Blesl, Andreas; Rainer, Florian; Wurm, Philipp; Durdević, Marija; Petritsch, Wolfgang; Wenzl, H; Baumann-Durchschein, Franziska; Posch, Andreas E.; Streit, A; Gorkiewicz, Gregor; Gröchenig, HP; Kump, Patrizia; Högenauer, Christoph

doi:10.1093/ecco-jcc/jjy222.718

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“…However, clinical response of IBD to FMT has shown extensive inter-study heterogeneity [ 22 ], which might stem from the variable engraftment of donor derived microbes and the high or persistent populations of unfavorable pathobionts in the host [ 23 , 24 , 25 , 26 ]. In this regard, both antibiotic pre-treatments (to lessen competitive interactions) and increased frequency of FMT delivery may both enhance the engraftment of putatively beneficial microbes, correcting dysbiotic populations, and promoting clinical response and disease remission [ 27 , 28 , 29 , 30 ]. While several trials utilizing either antibiotic pre-treatments [ 31 , 32 , 33 , 34 ] or repeated FMT regimens [ 35 , 36 ] have been conducted in patients with IBD, no pooled analyses of these findings exist, therefore hindering the optimization of FMT-based IBD therapies.…”

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confidence: 99%

Repeated Fecal Microbial Transplantations and Antibiotic Pre-Treatment Are Linked to Improved Clinical Response and Remission in Inflammatory Bowel Disease: A Systematic Review and Pooled Proportion Meta-Analysis

Mocanu

Rajaruban

Dang

et al. 2021

JCM

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The response of patients with inflammatory bowel disease (IBD) to fecal microbial transplantation (FMT) has been inconsistent possibly due to variable engraftment of donor microbiota. This failure to engraft has resulted in the use of several different strategies to attempt optimization of the recipient microbiota following FMT. The purpose of our study was to evaluate the effects of two distinct microbial strategies—antibiotic pre-treatment and repeated FMT dosing—on IBD outcomes. A systematic literature review was designed and implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A medical librarian conducted comprehensive searches in MEDLINE, Embase, Scopus, Web of Science Core Collection, and Cochrane Library on 25 November 2019 and updated on 29 January 2021. Primary outcomes of interest included comparing relapse and remission rates in patients with IBD for a single FMT dose, repeated FMT dosages, and antibiotic pre-treatment groups. Twenty-eight articles (six randomized trials, 20 cohort trials, two case series) containing 976 patients were identified. Meta-analysis revealed that both repeated FMT and antibiotic pre-treatment strategies demonstrated improvements in pooled response and remission rates. These clinical improvements were associated with increases in fecal microbiota richness and α-diversity, as well as the enrichment of several short-chain fatty acid (SCFA)-producing anaerobes including Bifidobacterium, Roseburia, Lachnospiraceae, Prevotella, Ruminococcus, and Clostridium related species.

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