Intest Res.  2022 Apr;20(2):251-259. 10.5217/ir.2021.00069.

Fecal microbiota transplantation for induction of remission, maintenance and rescue in patients with corticosteroid-dependent ulcerative colitis: a long-term follow-up real-world cohort study

• Seth AK
• Jain P

• KMID: 2529571
• DOI: http://doi.org/10.5217/ir.2021.00069

Abstract

Background/Aims
To study role of fecal microbiota transplantation (FMT) in induction, maintenance, and rescue in patients with corticosteroid-dependent ulcerative colitis (CDUC).
Methods
Patients with active CDUC received 3 fortnightly sessions of colonoscopic induction FMT (iFMT) in addition to standard of care. In patients who achieved clinical remission (CR) or response, prednisolone was tapered from week 4 and azathioprine from week 12. Responders were advised maintenance FMT (mFMT) every 6 months. Those with relapse were offered rescue FMT (rFMT), and low dose prednisolone was added if there was no improvement in 2 weeks.
Results
All 27 patients enrolled completed iFMT and were followed up for 39 months (range, 9–71 months). The mean Mayo score decreased from 6.4±2.5 at baseline to 2.6±3.7 at week 4, 2.6±3.4 at week 12, and 2.8±3.8 at week 24 (P<0.05). Corticosteroid-free CR and clinical response at week 12 were seen in 13 patients (48%) and 1 patient (3.7%), respectively. Corticosteroid and azathioprine-free CR at week 24 was seen in 13 patients (48%) and in them histological response was seen in 2 patients (15.2%) at week 4, 5 patients (38.4%) at week 12, and 10 patients (76.9%) at week 24. First relapse was seen in 10 of 13 responders (76.9%) at a median of 14.8 months (range, 6–34 months) after iFMT and was less frequent in patients on mFMT. Relapse was treated successfully with rFMT alone in 4 patients (40%) and rFMT with low dose steroids in 5 patients (50%).
Conclusions
iFMT, mFMT, and rFMT may have a role in treatment of selected patients with CDUC.

Keyword

Fecal microbiota transplant; Colitis, ulcerative; Colonoscopic fecal microbiota transplant

Figure

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  Fig. 1. Reduction in Mayo score after induction fecal microbiota transplantation (iFMT).

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  Fig. 2. Clinical remission and clinical response at weeks 4, 12, and 24 following induction fecal microbiota transplantation.

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  Fig. 3. Average relapse time and number of relapses in 10 out of 13 patients who achieved clinical remission at 24 weeks.

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  Fig. 4. Algorithm showing possible role of iFMT, mFMT, and rFMT in the treatment of corticosteroid dependent ulcerative colitis (UC) on thiopurines. FMT, fecal microbiota transplantation; iFMT, induction FMT; mFMT, maintenance FMT; rFMT, rescue FMT.

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  Fig. 5. Algorithm showing possible role of iFMT, mFMT and rFMT in the treatment of corticosteroid dependent ulcerative colitis (UC) who are thiopurine intolerant. FMT, fecal microbiota transplantation; iFMT, induction FMT; mFMT, maintenance FMT; rFMT, rescue FMT.

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