Q&A: ‘Future is bright’ for use of microbiota therapeutics in patients with IBD
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Key takeaways:
- Fecal microbiota therapeutics are “incredibly effective” for the treatment of Clostridiodes difficile infection.
- Fecal microbiota transplantation is not approved for IBD though it has “shown promise.”
In a Healio exclusive, Ari Grinspan, MD, predicted that while microbiota therapeutics are currently “not ready for prime time,” they will eventually become part of the treatment strategy for patients with inflammatory bowel disease.
“Manipulating the microbiome is an incredibly attractive therapy,” Grinspan, director of GI microbial therapeutics at Mount Sinai Health System and associate professor of gastroenterology at Icahn School of Medicine, told Healio. “We have already seen its remarkable efficacy in the treatment of Clostridiodes difficile infection. Patients have already bought into the concept and are eager to explore it further.”
He added, “While initial studies in IBD have been promising, there have been many speed bumps along the way and we are trying to help navigate the way forward.”
In a review published in The Lancet Gastroenterology & Hepatology, Grinspan and colleagues analyzed several clinical trials that investigated the use of fecal microbiota transplantation (FMT) for treatment of patients with IBD and summarized insights gained from these trials that could affect future research and FMT use.
In this Healio interview, Grinspan outlined key takeaways from the review and how findings could inform patient care and research directives in the years ahead.
Healio: What were the key takeaways?
Grinspan: Microbiome manipulation, via FMT and live biotherapeutic products (LBP), is incredibly effective for the treatment of C. diff infection. We now have two FDA approved FMT products to treat C. diff in Rebyota (fecal microbiota, live-jslm; Ferring Pharmaceuticals) and Vowst (fecal microbiota spores, live-brpk, Nestlé Health Science/Seres Therapeutics), and LBPs are on the horizon.
Initial studies of using FMT in IBD, specifically UC, have shown promise but we need to change our approach to maximize the efficacy of this new therapeutic target. Combining therapies that target the microbiome with currently available drugs that alter the immune system may be the best way forward.
Healio: What is the significance of these results?
Grinspan: Microbiota therapeutics, such as FMT, offer a novel avenue for clinicians to tailor their IBD treatment strategies. In the future, clinicians may consider these therapies as an additional tool in their arsenal when developing patient treatment plans.
Healio: What does this mean for patient care moving forward?
Grinspan: The insights discussed in this investigation will propel the science of IBD medicine into innovative new heights, given that the therapeutic effectiveness of current treatment options for the entire IBD patient population has only seen minimal improvement over the past decade.
The future is bright. While not ready for prime time, microbiota-based therapies will be a part of our armamentarium in the future.
Healio: What additional research is needed?
Grinspan: Future investigations should focus on identifying ideal patients for these therapies, effectiveness of maintaining disease remission, standardizing drug preparation and doses across recipients as well as exploring combination therapies within the existing IBD drug landscape.
Furthermore, a transition of donor-based FMT to in vitro manufactured defined consortia of beneficial bacteria would increase safety and scalability dramatically.
Healio: What else should our readers know about this?
Grinspan: At this time, FMT is not an approved therapy for IBD. FMT should only be used to treat C. diff infections.
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