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Systematic review with meta‐analysis: faecal microbiota transplantation for the induction of remission for active ulcerative colitis
Author(s) -
Costello S. P.,
Soo W.,
Bryant R. V.,
Jairath V.,
Hart A. L.,
Andrews J. M.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14173
Subject(s) - medicine , ulcerative colitis , cochrane library , odds ratio , randomized controlled trial , meta analysis , placebo , transplantation , blinding , cohort study , gastroenterology , surgery , pathology , disease , alternative medicine
Summary Background Faecal microbiota transplantation ( FMT ) is emerging as a novel therapy for ulcerative colitis ( UC ). Interpretation of efficacy of FMT for UC is complicated by differences among studies in blinding, FMT administration procedures, intensity of therapy and donor stool processing methods. Aim To determine whether FMT is effective and safe for the induction of remission in active UC . Methods Medline (Ovid), Embase and the Cochrane Library were searched from inception through February 2017. Original studies reporting remission rates following FMT for active UC were included. All study designs were included in the systematic review and a meta‐analysis performed including only randomised controlled trials ( RCT s). Results There were 14 cohort studies and four RCT s that used markedly different protocols. In the meta‐analysis of RCT s, clinical remission was achieved in 39 of 140 (28%) patients in the donor FMT groups compared with 13 of 137 (9%) patients in the placebo groups; odds ratio 3.67 (95% CI : 1.82‐7.39, P <.01). Clinical response was achieved in 69 of 140 (49%) donor FMT patients compared to 38 of 137 (28%) placebo patients; odds ratio 2.48 (95% CI : 1.18‐5.21, P =.02). In cohort studies, 39 of 168 (24%; 95% CI : 11%‐40%) achieved clinical remission. Conclusions Despite variation in processes, FMT appears to be effective for induction of remission in UC , with no major short‐term safety signals. Further studies are needed to better define dose frequency and preparation methods, and to explore its feasibility, efficacy and safety as a maintenance agent.