FMT trialled for kids with UC

The first randomised controlled trial of faecal microbiota transplant for ulcerative colitis in children has delivered positive results, but it is too early to recommend FMT in clinical practice for children, Canadian researchers say.

The study was able to recruit only half its target of 50 children with UC to be randomised to FMT or control, with recruitment made difficult by strict eligibility criteria, onerous clinic attendance schedules and withdrawal due to children being placed on other therapies such as biologics.

The composite clinical endpoint (improvement in pediatric ulcerative colitis activity index, C-reactive protein, or faecal calprotectin) was reached in 11 of 12 children assigned to FMT vs. 6 of 12 assigned to placebo at six weeks, with responses maintained up to 24 weeks in most children.

The study investigators said future trials of FMT in children are warranted and could learn from the lessons of the pilot RCT.

The findings are published in Gastroenterology

bDMARD prescribing program targets gastroenterologists

New IBD prescribing resources are being promoted to gastroenterologists as part of a government-funded program to achieve better value in bDMARD prescribing.

The tools, which include decision aids and actions plans to encourage adherence to low-dose methotrexate and thiopurines, are produced by the Targeted Therapies Alliance and NPS MedicineWise.

The tools were developed in conjunction with the Gastroenterological Society of Australia (GESA) said Associate Professor Jakob Begun, Chair of the GESA IBD Faculty.

“These new tools will be a valuable resource for health care professionals and our IBD patients, leading to improved outcomes through better use of IBD medications,” he said.

The resources are part of a wider three-year program targeting biologics prescribing in rheumatology and dermatology “to ensure the best possible health and economic outcomes from the use of bDMARDs and other specialised medicines”, according to NPS Medicinewise.

HCV halved in prisons with DAA treatment

An Australian trial has provided compelling evidence of the benefit of direct acting antivirals (DAAs) in HCV treatment-as-prevention in the prison setting.

The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study demonstrated a halving in HCV incidence from 8·31 to 4.35 per 100 person-years in prisons where DAA treatment (12 weeks of sofosbuvir plus velpatasvir) was scaled up after 2017.

The benefits were seen mostly in high risk subgroups at increased risk of HCV infection, such as people with a history of injecting drug use

However the investigators said their finding that HCV was not reduced in people who were injecting drugs during their imprisonment reinforced the need for comprehensive HCV prevention and intervention packages delivered in prison settings, including needle and syringe programs.

Lancet Gastroenterology and Hepatology.