Fecal transplant shows long-term safety for recurrent C. difficile

Fecal microbiota transplantation for recurrent Clostridium difficile infection showed long-term safety and benefits over antibiotic therapy in a recent study.

“Our study confirms that FMT is an effective and safe treatment for recurrent C. difficile infection also in [the] long-term,” investigators from Helsinki University Hospital in Finland wrote. “FMT did not affect the patients’ weight or increase the risk of severe diseases such as cancer, autoimmune diseases or allergies compared to patients treated only with antibiotics. Furthermore, our results suggest that FMT has some favorable effects for the GI symptoms compared to the antibiotic treatment and also the clearance of GI symptoms after the infection was faster in patients receiving FMT.”

Patients even reported they would prefer FMT over antibiotic therapy, despite the prejudices associated with this treatment, they noted.

To evaluate the long-term effects of FMT, the research team sent a 45-item questionnaire to 84 patients in the area who were successfully treated for recurrent C. difficile infection between 2007 and 2014.

Overall, 45 received FMT and 39 controls received antibiotics (mean follow-up, 3.8 years). Investigators matched groups by age and sex, and women comprised the majority of both (FMT group = 77.8% and control group = 79.5%,).

The survey included questions on patient recovery, medical status, quality of life, GI symptoms and new diseases possibly related to treatment.

They found no significant difference in starting weight or weight gain between patients treated with FMT or antibiotics.

“On average 80% of the patients gained weight after the treatment (average weight gain 1.9 kg), however, the range of weight gain/loss varied in both groups,” they wrote.

They also observed no statistical differences in the development of severe diseases — including inflammatory bowel disease, cancer, autoimmune diseases, allergies or neurological disease — between patients treated with FMT or antibiotics.

Further, patients who received FMT reported significantly faster improvement in their bowel habits, less irregular bowel function and less upper GI tract symptoms vs. those treated with antibiotics. Overall, 11.1% of the FMT patients reported worsened or more irregular bowel function after clearing the infection vs. 35.9% of patients treated with antibiotics (P = .034). Conversely, 53.3% of FMT patients vs. 25.6% of those treated with antibiotics reported improved and more regular bowel function after treatment (P = .016). Additionally, 77.8% of FMT patients reported GI symptoms related to irritable bowel syndrome compared with 92.3% of those treated with antibiotics (P = .06), and FMT patients also reported fewer upper intestinal symptoms (31.1% vs. 51.3%; P = .045).

Patients also reported that their mental health improved after FMT. While most patients reported no change, 31.1% of the FMT patients vs. 8.9% of those treated with antibiotics reported improved mental health after treatment (P = .06).

Finally, both FMT and antibiotic patients reported significantly higher willingness to receive FMT for another recurrent C. difficile infection rather than other treatment options. Overall, 97.6% of FMT patients said they would prefer FMT as their initial treatment rather than antibiotics in the future, and 60% of those treated with antibiotics said the same, and 33.3% said they would be willing to try FMT if antibiotics failed.

“The safety of the FMT, both short- and long term as well as reduced GI symptoms in the FMT group suggest that FMT treatment could be considered earlier as a treatment option,” the researchers concluded. – by Adam Leitenberger

Disclosures: The authors report no relevant financial disclosures.