Faecal microbiota transplantation (FMT) offers no advantage for patients with active peripheral psoriatic arthritis.
The findings challenge enthusiasm for a relationship between microbial dysbiosis and joint inflammation as per gut inflammation.
The FLORA trial, presented at EULAR 2021, evaluated the effectiveness and safety of single donor FMT versus sham FMT in 31 adult patients with PsA who were stable on at least three months of methotrexate treatment. A single dose of FMT or sham was delivered into the duodenum via gastroscope.
Dr Maja Kragsnaes, from the Research Unit of Rheumatology at the University of Southern Denmark and Odense University Hospital, told the Virtual Congress that significantly more FMT patients than controls experienced treatment failure or required treatment escalation by 26 weeks (60% v 19%; p=0.018).
In particular, more patients in the FMT group started biologic therapy than controls (53% v 19%) and more patients in the FMT group received >1 intraarticular glucocorticoid injection (13% v 6%).
In secondary endpoints, the HAQ-DI score improved more in the sham group indicating better physical function (-0.07 v -0.30; p=0.031).
“Although the FMT intervention did not induce beneficial effects, in the majority of people receiving the intervention the safety profile seemed to be acceptable,” she said.