Fecal Microbiota Transplantation in Chronic Pouchitis: A Randomized, Parallel, Double-Blinded Clinical Trial

Background: In ulcerative colitis, a pouchitis is the most common long-term adverse effect after proctocolectomy and ilea! pouch-anal anastomosis. Approximately 5% of patients develop chronic antibiotic-dependent or antibiotic-refractory pouchitis without any effective treatment. The aim of this trial was to investigate the efficacy and safety of fecal microbiota transplantation in the treatment of chronic pouchitis. Methods: This was a single-center, double-blinded, parallel group trial comparing donor fecal microbiota transplantation with placebo (autologous transplant) in chronic pouchitis.Twenty-six patients were recruited at the Helsinki University Hospital between December 2017 and August 2018 and were randomly allocated a 1:1 ratio to either donor fecal microbiota transplantation or placebo. The protocol included 2 transplantations into the pouch on weeks 0 and 4, and patients were followed up for 52 weeks. Results: Nine patients in the intervention group and 8 patients in the placebo group relapsed during the 52-week follow-up, and the relapsefree survival did not differ between the groups (P = 0.183, log-rank; hazard ratio, 1.90 [95% confidence interval, 0.73-4.98; P = 0.1901). In the subgroup analysis of patients using continuous antibiotics before the study, the relapse-free survival was shorter in the intervention group (P= 0.004, log-rank; hazard ratio, 13.08 [95% confidence interval, 1.47-116.60; P= 0.0211). No major adverse effects were reported. Conclusions: The fecal microbiota transplantation treatment regime used in our study was not effective in the treatment of chronic pouchitis. The safety profile of fecal microbiota transplantation was good.

Automated summary

The fecal microbiota transplantation treatment did not show efficacy in treating chronic pouchitis, however the safety profile was good. Among patients who were using continuous antibiotics before the study, the relapse-free survival was shorter in the intervention group.