Superiority of Higher-Volume Fresh Feces Compared to Lower-Volume Frozen Feces in Fecal Microbiota Transplantation for Recurrent Clostridioides Difficile Colitis

Agarwal, Amol; Maheshwari, Anurag; Verma, Sandeep; Arrup, Denise; Phillips, Laila; Vinayek, Rakesh; Nair, Padmanabhan P.; Hagan, Matilda; Dutta, Sudhir K.

doi:10.1007/s10620-020-06459-0

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…Using the search strategy above, a total of 424 studies were screened, duplicates were removed and 8 studies, [9][10][11][12][13][14][15][16] including 4 RCTs and 4 observational studies (Tables 1 and 2) were included after rigorous screening. Among the 8 studies, each assessed fresh FMT, along with 6 also assessing Frozen FMT while 3 studies assessed Lyophilized FMT.…”

Section: Resultsmentioning

confidence: 99%

Fresh Versus Frozen Versus Lyophilized Fecal Microbiota Transplant for Recurrent Clostridium Difficile Infection

Gangwani¹,

Aziz

Aziz³

et al. 2022

Journal of Clinical Gastroenterology

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Introduction: Clostridium difficile Infection is a significant source of morbidity and mortality, which is on the rise. Fecal Microbiota Transplantation (FMT) is an alternative therapy to antibiotics with a high success rate and low relapse rate. Current data regarding the efficacy of the types of FMT used, namely fresh, frozen, and lyophilized is conflicting. Our review attempts to consolidate this data and highlight the most efficacious treatment currently available.Methodology: MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, SciELO, the Korean Citation Index, and Global Index Medicus were systematically searched from inception through May 3, 2022. Studies in which patients are undergoing any form of FMT who had failed antibiotic treatment previously were included. Both pairwise (direct) and network (direct + indirect) meta-analysis were performed using a random effects model and DerSimonian-Laird approach. A frequentist approach was used for network meta-analysis. Risk differences with (RD) with 95% confidence interval (CI) were calculated.Results: A total of 8 studies, including 4 RCTs and 4 cohort studies, were included with a total of 616 patients. Fresh FMT was determined to be most successful with 93% efficacy 95% CI (0.913 to 0.999) followed by frozen with 88% efficacy 95% CI (0.857 to 0.947) and lyophilized with 83% efficacy 95% CI (0.745 to 0.910). The direct meta-analysis showed no statistically significant difference between fresh and frozen group. (RD −0.051 95% CI −0.116 to 0.014 P = 0.178). No significant differences were noted in frozen versus lyophilized groups with an overall trend towards Fresh FM (RD −0.061 95% CI −0.038 to 0.160 P = 0.617). On network metaanalysis, when compared with fresh group, a lower recovery rate was noted with both frozen group (RD −0.06 95% CI −0.11 to 0.00 P = 0.05) and lyophilized group (RD −0.16 95% CI −0.27 to −0.05 P = 0.01). Conclusion:We conclude the efficacy of Frozen and Lyophilized preparations is high with no difference in direct comparison, and the relative efficacy reduction based on network analysis is outweighed by the safety, accessibility, and practicality of Frozen or Lyophilized preparations.

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Section: Resultsmentioning

confidence: 99%

Fresh Versus Frozen Versus Lyophilized Fecal Microbiota Transplant for Recurrent Clostridium Difficile Infection

Gangwani¹,

Aziz

Aziz³

et al. 2022

Journal of Clinical Gastroenterology

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“…In our study, there was no significant difference found between the fresh stool (clinical remission rate: 40.9%) and frozen stool (clinical remission rate: 32.2%). Moreover, some studies have found that fresh FMT has superior clinical efficacy to frozen FMT [ 34 ]. Hamilton et al [ 35 ] found that frozen stool microbiota from a healthy donor was more effective in treating recurrent CDI, thereby restoring the structure of the gut microbiota and clearing C. difficile .…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Randomized Controlled Trials of Fecal Microbiota Transplantation for the Treatment of Inflammatory Bowel Disease

Tan

Xie

Liu

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objectives. Inflammatory bowel disease (IBD) is a chronic recurrent inflammatory disease of the gastrointestinal tract, and its prevalence is increasing worldwide. Fecal microbiota transplantation (FMT) is an emerging therapy that modifies the patient’s gut microbiota by transplanting feces from a healthy donor to achieve disease remission. However, its efficacy and safety need to be further investigated. Methods. PubMed, the Cochrane Library, Web of Science, Embase, and Google Scholar databases (up to 8th November 2021) were searched and literature was screened by title and abstract as well as full text. The primary outcome was clinical remission, with the clinical response as a secondary outcome. Risk ratios (RR) with 95% confidence intervals (CI) were reported. Results. A total of 14 trials were included in this study. In terms of clinical remission, FMT had a significant effect compared to placebo (RR = 1.44, 95 CI%: 1.03 to 2.02, I2 = 38%, P = 0.03 ), with no significant risk of study heterogeneity. Moreover, FMT led to significant results in clinical response compared to placebo with moderate between-study heterogeneity (RR = 1.34, 95 CI%: 0.92 to 1.94, I2 = 51%, P = 0.12 ). Subgroup analysis showed a higher clinical remission for fresh fecal FMT (40.9%) than that for frozen fecal FMT (32.2%); the efficacy of gastrointestinal (GI) pretreatment, the severity of disease, route of administration, and the donor selection remain unclear and require more extensive study. Safety analysis concluded that most adverse events were mild and self-resolving. The microbiological analysis found that the patient’s gut microbiota varied in favor of the donor, with increased flora diversity and species richness. Conclusion. FMT is a safe, effective, and well-tolerated therapy. Studies have found that fresh fecal microbiota transplant can increase clinical remission rates. However, more randomized controlled trials and long-term follow-ups are needed to assess its long-term effectiveness and safety.

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Methodology, efficacy and safety of fecal microbiota transplantation in treating inflammatory bowel disease

Ding

Yang

Wang

2020

Medicine in Microecology

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Superiority of Higher-Volume Fresh Feces Compared to Lower-Volume Frozen Feces in Fecal Microbiota Transplantation for Recurrent Clostridioides Difficile Colitis

Cited by 4 publications

References 18 publications

Fresh Versus Frozen Versus Lyophilized Fecal Microbiota Transplant for Recurrent Clostridium Difficile Infection

Fresh Versus Frozen Versus Lyophilized Fecal Microbiota Transplant for Recurrent Clostridium Difficile Infection

A Systematic Review and Meta-Analysis of Randomized Controlled Trials of Fecal Microbiota Transplantation for the Treatment of Inflammatory Bowel Disease

Methodology, efficacy and safety of fecal microbiota transplantation in treating inflammatory bowel disease

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