Low cure rates in controlled trials of fecal microbiota transplantation for recurrent clostridium difficile infection: A systematic review and meta-analysis

Raseen Tariq, Darrell Spencer Pardi, Mark G. Bartlett, Sahil Khanna

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background Fecal microbiota transplantation (FMT) is highly effective for treating recurrent Clostridium difficile infection (CDI) in observational studies (>90%), but cure rates in clinical trials are lower. We performed a systematic review and meta-analysis to assess the efficacy of FMT for recurrent CDI in open-label studies and clinical trials. Methods A systematic search from January 1978 to March 2017 was performed to include clinical trials of FMT for CDI. We analyzed CDI resolution by calculating weighted pooled rates (WPRs). Results Thirteen trials were included, comprising 610 patients with CDI treated with single FMT. Overall, 439 patients had clinical cure (WPR, 76.1%; 95% confidence interval (CI), 66.4%-85.7%). There was significant heterogeneity among studies (I 2 = 91.35%). Cure rates were lower in randomized trials (139/216 patients; WPR, 67.7%; 95% CI, 54.2%-81.3%) than in open-label studies (300/394 patients; WPR, 82.7%; 71.1%-94.3%) (P <.001). Subgroup analysis by FMT delivery modality showed lower cure rates with enema than colonoscopy (WPR, 66.3% vs 87.4%; P <.001) but no difference between colonoscopy and oral delivery (WPR, 87.4% vs 81.4%; P =.17). Lower rates were seen for studies including both recurrent and refractory CDI than for those including only recurrent CDI (WPR, 63.9% vs 79%; P <.001). Conclusions FMT was associated with lower cure rates in randomized trials than in open-label and in observational studies. Colonoscopy and oral route are more effective than enema for stool delivery. The efficacy also seems to be higher for recurrent than for refractory CDI.

Original languageEnglish (US)
Pages (from-to)1351-1358
Number of pages8
JournalClinical Infectious Diseases
Volume68
Issue number8
DOIs
StatePublished - Apr 8 2019

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Clostridium Infections
Clostridium difficile
Meta-Analysis
Colonoscopy
Enema
Clinical Trials
Observational Studies
Confidence Intervals
Fecal Microbiota Transplantation

Keywords

  • clinical cure
  • Clostridium difficile infection
  • controlled trials
  • fecal microbiota transplantation
  • meta-analysis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Low cure rates in controlled trials of fecal microbiota transplantation for recurrent clostridium difficile infection : A systematic review and meta-analysis. / Tariq, Raseen; Pardi, Darrell Spencer; Bartlett, Mark G.; Khanna, Sahil.

In: Clinical Infectious Diseases, Vol. 68, No. 8, 08.04.2019, p. 1351-1358.

Research output: Contribution to journalArticle

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title = "Low cure rates in controlled trials of fecal microbiota transplantation for recurrent clostridium difficile infection: A systematic review and meta-analysis",
abstract = "Background Fecal microbiota transplantation (FMT) is highly effective for treating recurrent Clostridium difficile infection (CDI) in observational studies (>90{\%}), but cure rates in clinical trials are lower. We performed a systematic review and meta-analysis to assess the efficacy of FMT for recurrent CDI in open-label studies and clinical trials. Methods A systematic search from January 1978 to March 2017 was performed to include clinical trials of FMT for CDI. We analyzed CDI resolution by calculating weighted pooled rates (WPRs). Results Thirteen trials were included, comprising 610 patients with CDI treated with single FMT. Overall, 439 patients had clinical cure (WPR, 76.1{\%}; 95{\%} confidence interval (CI), 66.4{\%}-85.7{\%}). There was significant heterogeneity among studies (I 2 = 91.35{\%}). Cure rates were lower in randomized trials (139/216 patients; WPR, 67.7{\%}; 95{\%} CI, 54.2{\%}-81.3{\%}) than in open-label studies (300/394 patients; WPR, 82.7{\%}; 71.1{\%}-94.3{\%}) (P <.001). Subgroup analysis by FMT delivery modality showed lower cure rates with enema than colonoscopy (WPR, 66.3{\%} vs 87.4{\%}; P <.001) but no difference between colonoscopy and oral delivery (WPR, 87.4{\%} vs 81.4{\%}; P =.17). Lower rates were seen for studies including both recurrent and refractory CDI than for those including only recurrent CDI (WPR, 63.9{\%} vs 79{\%}; P <.001). Conclusions FMT was associated with lower cure rates in randomized trials than in open-label and in observational studies. Colonoscopy and oral route are more effective than enema for stool delivery. The efficacy also seems to be higher for recurrent than for refractory CDI.",
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N2 - Background Fecal microbiota transplantation (FMT) is highly effective for treating recurrent Clostridium difficile infection (CDI) in observational studies (>90%), but cure rates in clinical trials are lower. We performed a systematic review and meta-analysis to assess the efficacy of FMT for recurrent CDI in open-label studies and clinical trials. Methods A systematic search from January 1978 to March 2017 was performed to include clinical trials of FMT for CDI. We analyzed CDI resolution by calculating weighted pooled rates (WPRs). Results Thirteen trials were included, comprising 610 patients with CDI treated with single FMT. Overall, 439 patients had clinical cure (WPR, 76.1%; 95% confidence interval (CI), 66.4%-85.7%). There was significant heterogeneity among studies (I 2 = 91.35%). Cure rates were lower in randomized trials (139/216 patients; WPR, 67.7%; 95% CI, 54.2%-81.3%) than in open-label studies (300/394 patients; WPR, 82.7%; 71.1%-94.3%) (P <.001). Subgroup analysis by FMT delivery modality showed lower cure rates with enema than colonoscopy (WPR, 66.3% vs 87.4%; P <.001) but no difference between colonoscopy and oral delivery (WPR, 87.4% vs 81.4%; P =.17). Lower rates were seen for studies including both recurrent and refractory CDI than for those including only recurrent CDI (WPR, 63.9% vs 79%; P <.001). Conclusions FMT was associated with lower cure rates in randomized trials than in open-label and in observational studies. Colonoscopy and oral route are more effective than enema for stool delivery. The efficacy also seems to be higher for recurrent than for refractory CDI.

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