IMT Improves Clinical Outcomes in IBD: Meta-Analysis

VANCOUVER, Canada — Intestinal microbiota transplant (IMT), also commonly referred to as fecal microbiota transplant (FMT), significantly improves clinical response and clinical remission among people with inflammatory bowel disease (IBD) compared with standard treatment, a meta-analysis reveals.

"But there was no statistical improvement in endoscopic remission, which is — at the end of the day — the goal for all of us," said Ifrah Fatima, MD, an internal medicine resident at University of Missouri-Kansas City School of Medicine.

Dr Ifrah Fatima

The belief is that people with ulcerative colitis or Crohn’s disease could benefit from IMT if it restores the balance of bacteria making up the gut microbiome, said Fatima, when presenting the findings during a poster session at the American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting.

Fatima and colleagues searched standard medical publication databases and identified 10 randomized control trials where investigators compared IMT with standard IBD care. Most participants — 83% — had ulcerative colitis and 17% had Crohn’s disease. The mean age was 39 years for the combined IMT groups vs 35 years in the combined control groups.

People receiving IMT were about 2.5 times more likely to achieve clinical remission than people in the standard care group (odds ratio [OR], 2.47; 95% CI, 1.57-3.88; P < .01). The IMT recipients also were about twice as likely to achieve clinical response (OR, 1.99; 95% CI, 1.18-3.34; P = .01).

Although the IMT group was more likely to experience endoscopic remission, it was not a statistically significant difference (OR, 1.89; 95% CI, 0.93-3.83; P = .08).

In addition, IMT was not associated with significantly worsening colitis compared with standard treatment (OR, 0.75; 95% CI, 0.38-1.48; P = .40).

"You know from these studies it's not harming a lot of people," Fatima said.

In a subanalysis, Fatima and colleagues compared IMT efficacy in ulcerative colitis vs Crohn’s disease.

They found significantly improved clinical remission in people with ulcerative colitis (OR, 2.6; 95% CI, 1.63-4.15; P < .01) but not in those with Crohn’s disease (OR, 2.26; 95% CI, 0.25-20.12; P < .46).

The same was true for significantly improved clinical response favoring IMT in people with ulcerative colitis (OR, 2.4; 95% CI, 1.14-3.62; P < .02). Improvements among people with Crohn’s disease were not statistically significant (OR, 1.33; 95% CI, 0.24-7.28; P < .46).

The next step for Fatima and colleagues is preparing a full manuscript for publication.

Time to Assess Endoscopic Remission

"While the results of previously conducted randomized controlled trials may vary depending on formulation, preparation, and mode of delivery, this analysis reaffirmed the beneficial effects of FMT, especially in ulcerative colitis," said Tauseef Ali, MD, director of SSM Health Crohn's and Colitis Center, Oklahoma City, Oklahoma.

"Surprisingly, no endoscopic remission benefit was reported in the present meta-analysis," noted Ali, who was not involved in the study. "This likely could be related to time to assess the endoscopic remission or varying definitions and assessments for endoscopic remission in clinical trials. Perhaps endoscopic response or improvement could be a better endpoint.

"Future larger scale studies with more standardized formulations and mode of delivery could be beneficial to evaluate endoscopic improvement and sustained remission with FMT in IBD, especially in Crohn’s disease and pouchitis," he added.

"Perhaps one day we [will be able] to address personal microbial signature to predict response to IBD therapy or manipulate it to achieve sustained remission and healing," Ali said.

American College of Gastroenterology (ACG 2023). Abstract P3624. Presented October 23, 2023.

The study was independently supported. Fatima and Ali report no relevant financial relationships.

Damian McNamara is a staff journalist based in Miami, Florida. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

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