fmt in ibd walter reinisch department of medicine mcmaster university hamilton, on
TRANSCRIPT
FMT in IBD
Walter Reinisch
Department of Medicine
McMaster University
Hamilton, ON
Grey’s Anatomy, November 2008
Willingness to Undergo FMT in Patients with UC
Kahn SA et al. Inflamm Bowel Dis 2013
Adapted from Shanahan F et al. Gastroenterology 2014
C. Diff. Infection ≠ IBD
C. diff.=Acute Infection
IBD =Chronic Inflammation
Wei W et al. JCM 2014
Dysbiosis in IBD
HC = healthy controls, ACD = acute CD, RCD = CD in remission, AUC = acute UC, RUC = UC in remission
Dysbiosis in IBD:Cause or Consequence of Inflammation
Antibiotics for active UC
Khan KJ et al. AJG 2011
Nine trials, 622 patients NNT = 7 (95% CI = 4 to 25)
Kruis, W., et al. Gut 2004;
Relapse rate within 1 year
Per-Protocol-Analysis (N = 222)
36,4%
0%
20%
40%
60%
80%
100%
33,9%
Equivalence significant with p = 0,003
E. Coli Nissle MESALAZIN
Probiotics for Maintenance of
Remission in UC
Anderson JL et al. Aliment Pharmacol Ther 2012
FMT and IBD
Management of IBD: 63% disease remission
Heterogeneity among Studies
UC > CD; (some with C.diff infection)
Disease characteristics incomplete (duration, location, disease
activity, endoscopic picture, concomitant treatment)
Patient preparation (lavage, antibiotics, PPI)
Stool preparation (g/mL saline, volume instilled)
Route of administration (naso-gastric, -jejunal, colonoscopy,
enema)
Number of administration (single, multiple)
Donor relationship (relatives, unrelated, one or multiple donors)
Outcomes (subjective, score-based)
Duration of follow-up
Angelberger S et al. AJG 2013
60 gr
250 ml
100 ml
Feces Preparation and Transplantation
Angelberger S et al. AJG 2013
Patient (f/m) 5 (2/3)
Age year, median (range) 27 (22-51)
Age at diagnosis, year, median (range) 26 (18-47)
Extent, n
extensive 4
left-sided 1
Failure to
AZA 4
MTX 2
CsA 3
IFX 4
ADA 2
Median total Mayo Score (range), baseline 11 (8-11)
FMT via enema, gr (range) 20 (6-21.7)
FMT via tube, gr (range) 23.8 (16.7-25)
Antibiotics (Metronidazol), n 5
Probiotics, n 4
Patient Characteristics
Angelberger S et al. AJG 2013
FMT design
Angelberger S et al. AJG 2013
Safety
no SAE
no „bacterial overgrowth“ (glucose breath test wks 4 and 12)
AEs:
FMT, n Follow-up, n
Worsening of diarrhoe 5 Common cold 3
Fever* 5 Itchiness 1
Increase in CRP# 5 Erythema 1
Flatulence 1 Paresthesia (hip) 1
Vomiting 1 Collapse 1
Blister (tongue) 1
Angelberger S et al. AJG 2013
CRP course
Angelberger S et al. AJG 2013
Efficacy
Angelberger S et al. AJG 2013
Dynamic change in microbiome
Angelberger S et al. AJG 2013