P1657 - Is Fecal Microbiota Transplantation an Effective Therapeutic Modality for the Treatment of Active Inflammatory Bowel Disease? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nabil El Hage Chehade, MD¹, Anastasia Chahine, MD², Nour El Hage Chehade, MD³, Sara Ghoneim, MD⁴, Ali El Mokahal, MD⁵, David G. Binion, MD⁶, Jana Hashash, MD, MSc^7
1Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; ²H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, CA; ³Cleveland Clinic Foundation, Cleveland, OH; ⁴University of Nebraska Medical Center, Omaha, NE; ⁵MetroHealth Medical Center, Cleveland, OH; ⁶University of Pittsburgh Medical Center, Pittsburgh, PA; ⁷Mayo Clinic, Jacksonville, FL

Introduction: Fecal microbiota transplantation (FMT) has been investigated as a treatment option in inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). The safety and efficacy of FMT in IBD is still controversial. We performed a systematic review and meta-analysis to evaluate the benefit of FMT in patients with active IBD with a special focus on UC.

Methods: A literature search was performed using Scopus, PubMed/MEDLINE, and Cochrane databases in April 2021. Studies included patients with active IBD who either received FMT or placebo. Analysis was conducted using the Mantel-Haenszel model using the odds ratio (OR) to assess the rate of clinical, endoscopic, combined clinical & endoscopic remission, and serious adverse events. Subgroup analyses were performed based on frequency, mode, type of FMT delivery, and number of feces donors. Results were pooled together using Reviewer Manager 5.4 software, and heterogeneity was quantified using I² statistics.

Results: Ten randomized-controlled clinical trials involving 492 patients were included. Studies were rated moderate-to-high in terms of study design quality using the Collaboration Risk of Bias Tool and Jadad Scale. Our findings suggest that compared to placebo, FMT showed a significant benefit in inducing clinical remission (OR 2.48, 95% CI, 1.56, 3.93, P=0.0001). Sensitivity analysis eliminating 2 studies, one involving pediatric patients and another involving CD patients, showed that clinical remission in adult patients with active UC was significantly higher in the FMT group (OR 2.21, 95% CI [1.40, 3.48], P=0.006). Subgroup analysis of influencing factors demonstrated no differences between pooled or single feces donors (OR 2.18 versus 3.11, P=0.48), FMT delivery via the upper or lower gastrointestinal tract (OR 1.13 versus 2.79, P=0.14), fresh or frozen FMT (OR 2.65 versus 2.92, P=0.86), and high or lower frequency of delivery (OR 2.31 versus 2.48, P=0.73). Endoscopic (OR 4.25, P< 0.0001)) and combined endoscopic and clinical remission rates (OR 3.89, P=0.0001) in active UC were significantly higher in the FMT group versus placebo. Analysis of serious adverse events showed no significant difference between both groups (OR 1.77, P=0.17).

Discussion: FMT shows a clinical and endoscopic benefit in the treatment of active IBD, mainly UC, with a comparable safety profile to placebo. Future randomized controlled trials are needed to include more patients with CD and examine for recurrence rates.




Disclosures:


Nabil El Hage Chehade, MD¹, Anastasia Chahine, MD², Nour El Hage Chehade, MD³, Sara Ghoneim, MD⁴, Ali El Mokahal, MD⁵, David G. Binion, MD⁶, Jana Hashash, MD, MSc⁷. P1657 - Is Fecal Microbiota Transplantation an Effective Therapeutic Modality for the Treatment of Active Inflammatory Bowel Disease? A Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.