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More data needed on long-term outcomes of FMT for C. difficile
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Fecal microbiota transplantation appears highly effective for recurrent Clostridium difficile infection, but more data are required to determine its long-term safety and efficacy, according to results from a systematic review and meta-analysis.
“Assessment of long-term outcomes is essential, because not all recurrences and complications of FMT occur within a few weeks,” Jing-Yuan Fang, MD, PhD, from Renji Hospital, Shanghai Institute for Digestive Diseases, Shanghai Jiao-Tong University School of Medicine, China, and colleagues wrote. “Therefore, we conducted a meta-analysis to evaluate the long-term (≥ 90 days) efficacy and safety of FMT for CDI and explore the factors affecting long-term outcomes of FMT.”
Fang and colleagues searched relevant literature published up to September 2015 and included 18 observational studies (n = 611) in their analysis. They calculated a pooled primary cure rate of 91.2% (95% CI, 86.7%-94.8%), an overall recurrence rate of 5.5% (95% CI, 2.2%-10.3%), an early recurrence rate of 2.7% (95% CI, 0.7%-6%) and a late recurrence rate of 1.7% (95% CI, 0.4%-4.2%).
Primary cure rate was higher in younger (< 65 years) vs. older patients (≥ 65 years; P = .0003) and early recurrence rate was lower in younger vs. older patients (P = .0081). Primary cure rate was also higher among patients who received FMT via lower vs. upper GI route (P = .015). There were no significant differences based on donor type or number of prior CDI episodes.
Overall there were 38 deaths associated with relapsed CDI, an aggressive 027 strain or unrelated infectious disease. “The relation of death and FMT ranged from unrelated to possibly related,” the researchers wrote. Other GI related adverse events were mostly “short-lived, moderate and manageable. It was noteworthy that nine patients with a known history of IBD experienced a disease flare and/or required colectomy post-FMT therapy for CDI,” they added.
“In summary, FMT may be a highly effective and robust therapy for recurrent CDI,” the researchers wrote. “Overall, with the limited and marginally biased evidence provided by observational studies, there is a need for more RCTs and cohort studies with control groups to confirm the long-term efficacy and safety of FMT, as well as define the appropriate receiver, ideal donor and best procedure for its use.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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