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Faecal Microbial Transplantation is as Effective as Targeted Therapies for Induction of Clinical and Endoscopic Remission in Ulcerative Colitis: A Systematic Review and Network Meta-Analysis

34 Pages Posted: 16 Apr 2020

See all articles by Sudheer K. Vuyyuru

Sudheer K. Vuyyuru

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

Saurabh Kedia

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

Mani Kalaivani

All India Institute of Medical Sciences (AIIMS) - Department of Biostatistics

Pabitra Sahu

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

Bhaskar Kante

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

Peeyush Kumar

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

Mukesh Kumar Ranjan

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

Govind Makharia

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

Vineet Ahuja

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

More...

Abstract

Background: Microbiome manipulation with fecal microbiota transplantation (FMT) has shown efficacy in induction of remission in ulcerative colitis (UC), yet information on the comparative efficacy of FMT with other targeted therapies is lacking. We did a network meta-analysis to compare the efficacy and safety of FMT with targeted therapies for induction of remission in UC.

Methods: We analyzed data from randomized controlled trials(RCTs) evaluating induction of remission in adults with UC treated with anti-TNF (infliximab and adalimumab), anti-integrin (vedolizumab), anti-IL23(ustekinumab), Janus kinase (JAK) inhibitors (tofacitinib), and FMT, compared with placebo or another active agent. The outcomes assessed were induction of clinical remission, clinical response, endoscopic remission, and adverse events. Both pairwise and network meta-analysis were performed, and ranking was assessed using surface under the cumulative ranking(SUCRA) probabilities.

Findings: Overall nineteen studies were included, among which there was only one head to head RCT (adalimumab vs. vedolizumab). All interventions including FMT were superior to placebo in inducing clinical remission (except adalimumab-OR 1.66; 95% CI, 0.97-2.85), clinical response and endoscopic remission. FMT was comparable with other agents for all efficacy outcomes including clinical remission and response, and endoscopic remission. Infliximab was ranked highest in inducing clinical remission (SUCRA, 0.8), vedolizumab in clinical response (SUCRA, 0.9) and tofacitinib in endoscopic remission (SUCRA, 0.9). There was no difference in safety outcomes between FMT and other targeted therapies, among which ustekinumab ranked the safest.

Interpretation: FMT is as effective as targeted therapies in inducing clinical remission, response and endoscopic remission in patients with ulcerative colitis.

Funding Statement: None

Declaration of Interests: None.

Keywords: Biologicals; anti-TNF; Faecal microbial transplantation; Ulcerative colitis

Suggested Citation

Vuyyuru, Sudheer K. and Kedia, Saurabh and Kalaivani, Mani and Sahu, Pabitra and Kante, Bhaskar and Kumar, Peeyush and Kumar Ranjan, Mukesh and Makharia, Govind and Ahuja, Vineet, Faecal Microbial Transplantation is as Effective as Targeted Therapies for Induction of Clinical and Endoscopic Remission in Ulcerative Colitis: A Systematic Review and Network Meta-Analysis (3/11/2020). Available at SSRN: https://ssrn.com/abstract=3555235 or http://dx.doi.org/10.2139/ssrn.3555235

Sudheer K. Vuyyuru (Contact Author)

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

New Delhi
India

Saurabh Kedia

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

New Delhi
India

Mani Kalaivani

All India Institute of Medical Sciences (AIIMS) - Department of Biostatistics

India

Pabitra Sahu

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

New Delhi
India

Bhaskar Kante

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

New Delhi
India

Peeyush Kumar

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

New Delhi
India

Mukesh Kumar Ranjan

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

New Delhi
India

Govind Makharia

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition

New Delhi
India

Vineet Ahuja

All India Institute of Medical Sciences (AIIMS) - Department of Gastroenterology and Human Nutrition ( email )

New Delhi
India

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