Fecal microbiota transplantation in inflammatory bowel disease patients: A systematic review and meta-analysis

Abstract

Objectives Current evidence on fecal microbiota transplantation for inflammatory bowel disease is inconclusive. We conducted a systematic review to gather evidence on the efficacy and safety of fecal microbiota transplantation for inflammatory bowel disease. Methods Systematic searches were conducted in PubMed, Scopus, and Web of Science. Clinical remission was considered as the primary endpoint. Pairwise meta-analyses were performed for the randomized controlled studies (Mantel Haenszel, random effects model). Proportion meta-analyses, accounting for weighted pooled rates reported in the interventional studies, were conducted using the mixed effects model. Subgroup analyses considering the type of stool, donor type, and disease subtype were also performed. Cumulative meta-analyses to assess further needs of evidence were conducted. Results Sixty studies were included, from which 36 could be synthesized in the quantitative analyses. Pairwise meta-analyses of six controlled trials showed significant differences in favor of fecal microbiota transplantation compared with placebo (clinical remission: RR 1.70 [95% CI 1.12, 2.56]; clinical response: RR 1.68 [95% CI 1.04, 2.72]). An overall clinical remission of 37%, overall clinical response of 54%, and a prevalence of 29% of adverse events were found for the interventional studies. Frozen fecal material and universal donors were related to better efficacy outcomes. In addition, Crohn's disease patients seemed to benefit more from the procedure. Conclusions The comparative analyses demonstrated that frozen fecal material from universal donors may be related to a higher rate of clinical remission, especially for Crohn's disease.

Efficacy and safety of fecal microbiota transplantation for the treatment of diseases other than Clostridium difficile infection: a systematic review and meta-analysis

“… Appeared changed at two weeks (only data point). Not described Bajaj et al, 2017 32 and long term data reported in Bajaj et al, 2019 56 Yes Yes Changes appeared to persist for over one year (reported in long term paper). Not described Bajaj et al, 2019 33 Yes Not measured Appeared changed at day 30 (only data point).…”

“…Whilst other reviews have been conducted with respect to safety of FMT for indications other than CDI, these reviews are either not recent, 65 or were restricted to a single indication such as IBS [29][30][31] and IBD. [32][33][34] With respect to efficacy, whilst other reviews have been published for single indications, such as IBS [29][30][31] and IBD, [32][33][34] there have been no holistic reviews looking at all indications other than CDI. As far as the authors of this review are aware, this review also represents the most up to date systematic review and metaanalysis of the safety and efficacy of FMT for IBS.…”

“…There is also promising preclinical evidence supporting the use of FMT in conditions other than CDI, including Major Depressive Disorder, 25,26 schizophrenia, 27 and cardiometabolic syndrome. 28 While reviews of FMT for specific indications such as IBS [29][30][31] and IBD exist, [32][33][34] to date there have been no comprehensive reviews evaluating and synthesizing the entire body of data for both the efficacy and safety of FMT for all conditions other than CDI. This systematic review and metaanalysis addresses the question of whether FMT is safe and effective at treating health conditions other than CDI in humans.…”

“…While reviews of FMT for specific indications such as IBS 29–31 and IBD exist, 32–34 to date there have been no comprehensive reviews evaluating and synthesizing the entire body of data for both the efficacy and safety of FMT for all conditions other than CDI. This systematic review and meta-analysis addresses the question of whether FMT is safe and effective at treating health conditions other than CDI in humans.…”

Modern approaches to the correction of the gut microbiota

“…Имеющиеся данные об эффективности ТФМ в терапии СРК неоднозначны и противоречивы. В отдельных исследованиях имеются сообщения о возможных благоприятных эффектах данной стратегии лечения, улучшении клинической картины заболевания [71]. Между тем в ряде систематических обзоров сообщается об отсутствии убедительных доказательств эффективности ТФМ при СРК [72][73][74].…”