Faecal microbiota transplantation (FMT) has been shown to induce clinical remission in patients with ulcerative colitis but questions have been raised about the intensity of the treatment.
In an Australian study published recently in The Lancet, FMT by colonoscopic infusion was followed by multiple enemas – five days per week for eight weeks.
In an accompanying editorial, Professor Britta Siegmund from the Charité – Medical University of Berlin said the regimen contrasted markedly with the single FMT enema usually effective in patients with Clostridium difficile associated colitis.
She said ulcerative colitis was clearly more difficult to treat with FMT than C. difficile and queried why the study did not find evidence of improvements in quality of life after FMT.
“Whether this absence of effect is attributable to the rather demanding therapy remains to be clarified,” she said.
Professor Siegmund said further studies would also be required to ascertain a maintenance protocol for patients with ulcerative colitis.
Researcher Dr Sudarshan Paramsothy, now an advanced IBD fellow at the University of Chicago, told the limbic the protocol was necessarily intensive to definitively demonstrate that FMT was effective in ulcerative colitis.
However he said the treatment was well tolerated and drop out rates were low in both FMT and placebo arms of the study.
He added daily enema therapy with steroid or 5-ASA was commonly used in the induction treatment of patients with ulcerative colitis and active disease.
“With advances in encapsulated FMT – already demonstrated to be effective in C. difficile – the accessibility and tolerability of such therapy may be further improved in the future,” he said.
Preliminary findings from the multicenter study have previously been reported in the limbic – here and here. Essentially, 27% of patients who received FMT achieved steroid-free clinical remission compared to 8% of patients receiving placebo.
Three randomised controlled trials now support the efficacy of FMT in patients with ulcerative colitis.
The Australia study used transplants from multiple donors to achieve the highest microbial diversity, which is associated with favourable outcomes.