P0992 Real-world experience of faecal microbiota transplant in ulcerative colitis
Authors: Povlsen S , Merrick B , Yeo J H , Samaan M , Goldenberg S 
Published: January 2025

Background

Faecal microbiota transplant (FMT) is an effective treatment strategy for recurrent Clostridioides difficile infection (rCDI)1, but its role in ulcerative colitis (UC), another disease involving gut dysbiosis, is less certain2.

Methods

Patients with active UC at St Thomas’ hospital, London were given FMT according to patient preference and MDT decision. Local approval was granted for the new procedure process in May 2018. 200ml FMT (80g stool in 0.9% saline with 12.5% glycerol) was deposited in the terminal ileum or caecum at colonoscopy, with loperamide and an anal plug to aid retention. 60-90ml FMT was given via enema on days 2, 4 and 28. Demographics (table 1), Simple Clinical Colitis Activity Index (SCCAI), Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and faecal calprotectin were collected at baseline and over a 12-week follow-up (FU) period. Adverse events, hospital admissions, medication changes and colectomy incidence were recorded.

Results

10 FMT administrations across 9 patients between 2018 and 2024 were analysed retrospectively. All patients had improvement in at least one measurable index (SCCAI, UCEIS or calprotectin, mean FU 6 weeks for each parameter). In all measured cases SCCAI either improved (5/6; 83%) or remained static in steroid free clinical remission (1/6, 17%), mean improvement = 2.83. 2/6 (33%) were in steroid free clinical remission after FMT. UCEIS improved in 3/5 (60%) and remained static in 2/5 (40%), mean improvement = 1. Endoscopic response (improvement ≥2) occurred in 1/5 (20%). None achieved endoscopic remission during 12-week FU. Faecal calprotectin improved in all measured cases (n=4) and by ≥50% in 2/4 (50%), but all were receiving steroids either at the time of FMT or during FU. Steroids were started in 1/9 (11%) and biologic switched in 4/9 (44%) &lt;12 weeks after FMT. 2/9 (22%) had a biologic switch or dose escalation beyond 12 weeks. 2/9 (22%) required no change in treatment (figure 1). There were no adverse events, hospitalisations or colectomy during 12-week FU period. 2/9 patients went on to have colectomy, both &gt;2 years post FMT.

Conclusion

There was clinical response or maintenance of clinical remission after FMT in all patients. This was discordant with a relatively modest endoscopic improvement, suggesting a potential placebo effect. Most patients required a change of treatment either during the 12-week FU or shortly after. Analysis was limited by other concurrent medication changes and incomplete data. Extension of FMT administration may have captured further response but this would need further evaluation. FMT was safe to deliver with no adverse events documented, no hospitalisations and no colectomy during 12-week FU.

References

1.Mullish BH, Merrick B, Quraish MN, et al. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridioides difficile infection and other potential indications: second edition of joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines. Gut 2024;73:1-24.

2.Imdad A, Pandit NG, Zaman M, Minkoff NZ, Tanner-Smith EE, Gomez-Duarte OG, Acra S, Nicholson MR. Fecal transplantation for treatment of inflammatory bowel disease. Cochrane Database of Systematic Reviews 2023; 4(CD012774). DOI: 10.1002/14651858.CD012774.pub3. Accessed 18 November 2024.