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Studies show long-term benefits of fecal transplant for recurrent CDI
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More than 80% of patients who underwent fecal microbiota transplantation, or FMT, were free of Clostridium difficile recurrence approximately 22 months after the procedure, according to recent data in Clinical Infectious Diseases.
In addition, Colleen S. Kraft, MD, MSc, associate professor of pathology and laboratory medicine at Emory University School of Medicine, and colleagues found that most patients would prefer to undergo FMT again for recurrent C. difficile infection (RCDI) than receive antibiotic therapy. Their findings coincide with long-term data from a separate study published in Alimentary Pharmacology and Therapeutics, which showed that FMT provided more clinical benefits over antibiotic therapy.
“These findings underscore the value of FMT in avoiding repeated antibiotic administration that can perpetuate intestinal dysbiosis,” Kraft and colleagues wrote. “However, these data also highlight the limitations of FMT and other factors that modify risk of RCDI.”
Long-term efficacy of FMT
Current first-line treatments for CDI include oral vancomycin or metronidazole, according to the researchers. The prevalence of RCDI after antibiotic treatment ranges from 15% to 20% and can increase to 60% after patients’ first CDI reoccurrence. Although FMT has emerged as a new therapy for RCDI, long-term data on its efficacy are limited.
To gather more information on FMT, Kraft and colleagues conducted a telephone survey to assess the outcomes of 190 patients who underwent the procedure at Emory Hospital between July 2012 and December 2016. The median time from last FMT to the survey date was 22 months.
Of the 137 patients who completed the survey, 82% had no recurrence of CDI. Antibiotic use for non-CDI indications after FMT was higher among patients who had RCDI vs. patients without RCDI (75% vs. 38%; P = .0009). Further analysis showed that the use of cephalosporins, clindamycin and fluoroquinolones increased the odds of RCDI after FMT (OR = 3.78; 95% CI, 1.16-12.30).
Kraft and colleagues also found that 11% of patients reported improvement or resolution of non-CDI-related conditions, including pre-existing inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). However, two patients reported worsening of IBD, and 33% reported developing a new medical condition or symptom after FMT.
“This inconsistent response echoes the muddy signal from multiple recent clinical trials of FMT for IBD and IBS that have yet to demonstrate consistent therapeutic benefit, though many maintain hope that the intestinal microbiome will be an amenable therapeutic target for these debilitating diseases,” Kraft and colleagues wrote.
Long-term benefit of FMT
In another study, Jonna Jalanka, PhD, and colleagues at Helsinki University Hospital in Finland found that patients who underwent FMT for RCDI had significantly faster improvement in their bowel habits, less irregular bowel function and less upper gastrointestinal tract symptoms than patients treated with antibiotics. The researchers surveyed 45 patients who underwent FMT and 39 who received antibiotic therapy for RCDI between 2007 and 2014 (mean follow-up, 3.8 years). Data showed that 11% of patients who underwent FMT reported worsened or more irregular bowel function vs. 35.9% who received 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 IBS 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).
The results also indicated that FMT had an impact on mental health. More than 31% of patients who received FMT vs. 8.9% of those treated with antibiotics reported improved mental health after treatment (P = .06). There were no statistically significant differences in the development of severe diseases — including IBD, cancer, autoimmune diseases, allergies or neurological disease — between patients treated with FMT and those treated with antibiotics.
FMT preferred over antibiotics
In both studies, most patients said they would prefer FMT as their initial treatment for RCDI over antibiotic therapy. In their analysis, Kraft and colleagues found that 95% of patients were willing to have another FMT if they developed RCDI in the future. Seventy percent preferred FMT for future C. difficile episodes, whereas 26% preferred antibiotics. Meanwhile, Jalanka and colleagues found that 97.6% of patients who received FMT and 60% who received antibiotics would prefer FMT in the future. Approximately 33% of patients said they would be willing to try FMT if antibiotics failed.
“The ‘yuck factor’ associated with FMT is an oft-referenced barrier to more widespread use,” Kraft and colleagues concluded. “However, these data suggest that patients who undergo FMT for RCDI are highly satisfied with the procedure and testify to the significant patient-level burden of RCDI.” – by Stephanie Viguers and Adam Leitenberger
References:
Mamo Y, et al. Clin Infect Dis. 2017;doi:10.1093/cid/cix1097.
Jalanka J, et al. Aliment Pharmacol Ther. 2017;doi:10.1111/apt.14443.
Disclosures: Kraft reports serving on a scientific advisory board for Luminex Corporation, Inc. All other authors report no relevant financial disclosures.