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P594 Predictors of non-response to repeated faecal microbiota transplantation in patients with therapy refractory ulcerative colitis

A. Blesl*1, F. Rainer1, P. Wurm1, M. Durdevic1, W. Petritsch1, H. Wenzl1, F. Baumann-Durchschein1, A. Posch1, A. Streit1, G. Gorkiewicz1, H-P. Gröchenig2, P. Kump1, C. Högenauer1

1Medical University of Graz, Graz, Austria, 2Barmherzige Brüder St. Veit/Glan, St. Veit, Austria

Background

Double-blind randomised studies investigating faecal microbiota transplantation (FMT) in chronic active ulcerative colitis (UC) have shown promising results so far. Factors influencing the efficacy of FMT in UC still remain unclear. FMT protocols for the treatment of UC patients vary in dose, frequency, route of application and donor stool preparation and might thus influence remission rates. The aim of this analysis was to find clinical predictors for non-response to FMT in UC.

Methods

54 patients suffering from chronic active ulcerative colitis were treated with repeated FMT (5 times every second week) using the same protocol with the exception of donor stool preparation. Thirty patients (mean age 37 y ± 9) were treated with frozen donor stool (mixed with sodium chloride and glycerol, stored at −80°C) and 24 patients (mean age 43 y ± 14) with freshly prepared donor stool (not older than 6 h). Remission and response were determined by total Mayo score (TMS) before FMT and at Day 90. Clinical response was defined as a decrease of ≥3 points in TMS from baseline, along with either a decrease of >1 point in the rectal bleeding subscore or the absolute rectal bleeding subscore of 0 or 1. Remission was defined as a TMS <2 and an endoscopic subscore of 0 or 1. Clinical data as well as blood and stool analysis were assessed at any time point and potential predictors for non-response were calculated using regression analysis.

Results

At baseline patients had a total Mayo score of 9.0 ± 2.0 and an endoscopic subscore of 2.5 ± 1.0. 65% of patients had failed previous biologic therapy and 70% previous immunosuppressive treatment. In total 59% of patients responded to FMT, 24% achieved remission while 41% showed no response. The mean total Mayo score dropped to 5.3 ± 3.2 at Day 90. Non-response to biologics (hazard ratio (HR): 0.23 (95% CI 0.06–0.85), p: 0.03), a total Mayo score before FMT ≥9 (HR: 0.26 (95% CI 0.07–0.95), p: 0.04) and a high endoscopic subscore before FMT (HR: 0.27 (0.10–0.69, p < 0.01) were associated with lower remission rates. There was no significant difference in decrease of TMS (p = 0.51) or in remission and response rates (p = 0.97), respectively in patients receiving fresh or frozen donor stool at Day 90.

Conclusion

Failure to previous biologic treatment as well as a high total Mayo score and a high endoscopic subscore are associated with lower remission rates to FMT in chronic active ulcerative colitis.