P639 Faecal microbiota transplantation as a rescue therapy for steroid-dependent and/or non-responsive patients with ulcerative colitis: a pilot study.
T. Karakan*, M. İbiş, M. Cindoruk, Z. G. Sargin, N. Alizadeh
GAZI UNIVERSITY, GASTROENTEROLOGY, ANKARA, Turkey
Faecal microbiota transplantation (FMT) is an experimental method for restoration of dysbiosis in UC. Few studies reported improvement in clinical and endoscopical response. However, route of administration, donor and patient selection, number of FMT sessions, and intervals are still obscure. Steroid failure leads the patient to a next step of drugs. Immunomodulatory or biological agents have higher costs and adverse events, potential risks of infection and malignancy. We have analysed the efficacy of rescue FMT for steroid dependent and/or non-responsive UC patients.
In the study, 14 patients with steroid-dependent and/or non-responsive UC were enrolled, and treated with FMT. Follow-up clinical data was collected for at least 3 months (3–18 months). Donors were selected according to Amsterdam Criteria. All patients received FMT after complete colon cleansing via colon. Patient and donor clinical, demographic and laboratory data were recorded.
Of 14 patients, 11 (78.5 %) achieved clinical improvement and were able to discontinue steroids following rescue FMT. One patient was lost to follow-up. Amongst the 11 patients who responded, 5 (45.4 %) received 1 FMT therapy; 1 (9.0%) received 2 FMTs; 3 (27.2%) received 4 FMTs; and 2 (18.1%) received 6 FMTs. Further, 6 (54.5 %) of the 11 patients who responded maintained long-term remission during follow-up (3–18 months). Three patients (21.4 %) failed to meet the criteria of clinical improvement and maintained steroid dependence, though one patient experienced transient or partial improvement. Moreover 8 of 11 responders had the same blood group antigen with the corresponding donor. Patient age (28 ± 8 vs 47 ± 11yr, p < 0.05) and disease duration (6 ± 3 vs 35 ± 12 months, p < 0.05) were also lower in responders. Mean body mass index (kg/m2) increased in all responders (baseline: 23 ± 3 vs post-FMT 3 months: 26 ± 2, p < 0.05). None of the patients experienced major adverse events because of FMT.
Rescue FMT shows promise as a therapeutic strategy for patients with steroid-dependent and/or non-responsive UC, likely because of the successful restructuring of gut microbial composition. Blood group antigen-match might be a promising research area such as in other organ transplantations. Post-FMT weight gain might be due to cessation of inflammation or improved dysbiosis. Further studies are urgently needed to clarify predictive factors of success for FMT in this population.