Fecal microbiota transplantation to maintain remission in Crohn’s disease: a pilot randomized controlled study
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Published:2020-02-03
Issue:1
Volume:8
Page:
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ISSN:2049-2618
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Container-title:Microbiome
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language:en
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Short-container-title:Microbiome
Author:
Sokol HarryORCID, , Landman Cecilia, Seksik Philippe, Berard Laurence, Montil Mélissa, Nion-Larmurier Isabelle, Bourrier Anne, Le Gall Guillaume, Lalande Valérie, De Rougemont Alexis, Kirchgesner Julien, Daguenel Anne, Cachanado Marine, Rousseau Alexandra, Drouet Élodie, Rosenzwajg Michelle, Hagege Hervé, Dray Xavier, Klatzman David, Marteau Philippe, Beaugerie Laurent, Simon Tabassome
Abstract
Abstract
Background
The role of the gut microbiota in Crohn’s disease (CD) is established and fecal microbiota transplantation (FMT) is an attractive therapeutic strategy. No randomized controlled clinical trial results are available. We performed a randomized, single-blind, sham-controlled pilot trial of FMT in adults with colonic or ileo-colonic CD.
Method
Patients enrolled while in flare received oral corticosteroid. Once in clinical remission, patients were randomized to receive either FMT or sham transplantation during a colonoscopy. Corticosteroids were tapered and a second colonoscopy was performed at week 6. The primary endpoint was the implantation of the donor microbiota at week 6 (Sorensen index > 0.6).
Results
Eight patients received FMT and nine sham transplantation. None of the patients reached the primary endpoint. The steroid-free clinical remission rate at 10 and 24 weeks was 44.4% (4/9) and 33.3% (3/9) in the sham transplantation group and 87.5% (7/8) and 50.0% (4/8; one patient loss of follow-up while in remission at week 12 and considered in flare at week 24) in the FMT group. Crohn’s Disease Endoscopic Index of Severity decreased 6 weeks after FMT (p = 0.03) but not after sham transplantation (p = 0.8). Conversely, the CRP level increased 6 weeks after sham transplantation (p = 0.008) but not after FMT (p = 0.5). Absence of donor microbiota engraftment was associated with flare. No safety signal was identified.
Conclusion
The primary endpoint was not reached for any patient. In this pilot study, higher colonization by donor microbiota was associated with maintenance of remission. These results must be confirmed in larger studies (NCT02097797).
Funder
Ministère de l’Enseignement Supérieur, de la Recherche Scientifique et des Technologies de l'Information et de la Communication Fondation de France Assistance Publique - Hôpitaux de Paris Association Francois Aupetit
Publisher
Springer Science and Business Media LLC
Subject
Microbiology (medical),Microbiology
Reference30 articles.
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