Timing for the second fecal microbiota transplantation to maintain the long-term benefit from the first treatment for Crohn’s disease

Abstract

Increasing evidence has shown that fecal microbiota transplantation (FMT) could be a promising treatment option for Crohn’s disease (CD). However, the frequency of FMT for CD treatment remains unclear. This study aimed to evaluate the optimal timing for administering the second course of FMT to maintain the long-term clinical effects from the first FMT for patients with CD. Sixty-nine patients with active CD who underwent FMT twice and benefited from the first FMT were enrolled in this study. Clinical response, stool microbiota, and urine metabolome of patients were assessed during the follow-up. The median time of maintaining clinical response to the first FMT in total 69 patients was 125 days (IQR, 82.5–225.5). The time of maintaining clinical response to the second FMT in 56 of 69 patients was 176.5 days (IQR, 98.5–280). The fecal microbiota composition of each patient post the first FMT was closer to that of his/her donor. Compared to that of the baseline, patients prior to the second course of FMT showed significant differences in urinary metabolic profiles characterized by increased indoxyl sulfate, 4-hydroxyphenylacetate, creatinine, dimethylamine, glycylproline, hippurate, and trimethylamine oxide (TMAO). This study demonstrated that patients with CD could be administered the second course of FMT less than 4 months after the first FMT for maintaining the clinical benefits from the first FMT. This was supported by the host–microbial metabolism changes in patients with active CD. Trial registration: ClinicalTrials.gov, NCT01793831. Registered 18 February 2013. https://clinicaltrials.gov/ct2/show/NCT01793831?term=NCT01793831&rank=1Electronic supplementary materialThe online version of this article (10.1007/s00253-018-9447-x) contains supplementary material, which is available to authorized users.

Efficacy of faecal microbiota transplantation in Crohn’s disease: a new target treatment?

“…The median duration between the first and second course of FMT was 123 days in this cohort. This was similar to that in our previous study in which the median time of maintaining clinical response to the first FMT was 125 days (Li et al , ). We recommended 3 months post‐FMT as the ideal time for the second course of FMT in patients with CD (Li et al , ).…”

“…This was similar to that in our previous study in which the median time of maintaining clinical response to the first FMT was 125 days (Li et al , ). We recommended 3 months post‐FMT as the ideal time for the second course of FMT in patients with CD (Li et al , ). In terms of long‐term efficacy, it is noteworthy that until the end of follow‐up, nearly half (43.7%) of the patients achieved clinical response and one‐fifth (20.1%) of patients achieved sustained clinical remission after one or multiple courses of FMT.…”

“…A subsequent pilot study explored the timing for the second course of FMT in order to maintain the clinical response of the first FMT. Based on the evaluation of 69 patients with CD, 3 months after the first FMT was recommended as the appropriate time for the second course of FMT in patients with CD (Li et al , ).…”

Australian consensus statements for the regulation, production and use of faecal microbiota transplantation in clinical practice

“…Faecal microbiota transplantation (FMT) has proved to be an extremely effective treatment for recurrent Clostridioides difficile infection (CDI) 1–12. FMT is under evaluation for the induction of remission in active ulcerative colitis (UC),13–16 Crohn’s disease,17–22 irritable bowel syndrome23–30 and metabolic syndrome,31 among other potential indications. Despite growing use, substantial differences exist in the regulation of donor selection and screening, FMT production and delivery methods.…”

Just another crappy commentary: the future of fecal microbiota transplantation

“…Medical literature includes reports on FMT for C. difficile colitis [1] and other refractory bowel infections [9], ulcerative colitis [10,11] Crohn's disease [12], irritable bowel syndrome [13,14], sclerosing cholangitis [15], constipation [16], cirrhosis [17], hepatic encephalopathy [18,19], psoriatic arthritis [20], graft versus host disease [21], diabetic neuropathy [22] and metabolic syndrome [23][24][25], although data are sparse and sometimes negative or inconclusive for some of these indications. Additional indications are under study or were under study based on listings with clinicaltrials.gov and as shown in Table 1.…”