SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Frank ZERBIB
Coup de coeur :
 
 
Journal of the American Medical Association (JAMA)
  2019/01  
 
  2019 Jan 15;321(2):156-164.  
  doi: 10.1001/jama.2018.20046.  
 
  Effect of Fecal Microbiota Transplantation on 8-Week Remission in Patients With Ulcerative Colitis: A Randomized Clinical Trial.  
 
  Costello SP, Hughes PA, Waters O, Bryant RV, Vincent AD, Blatchford P, Katsikeros R, Makanyanga J, Campaniello MA, Mavrangelos C, Rosewarne CP, Bickley C, Peters C, Schoeman MN, Conlon MA, Roberts-Thomson IC, Andrews JM  
  https://www.ncbi.nlm.nih.gov/pubmed/30644982  
 
 

Abstract

IMPORTANCE:

High-intensity, aerobically prepared fecal microbiota transplantation (FMT) has demonstrated efficacy in treating active ulcerative colitis (UC). FMT protocols involving anaerobic stool processing methods may enhance microbial viability and allow efficacy with a lower treatment intensity.

OBJECTIVE:

To assess the efficacy of a short duration of FMT therapy to induce remission in UC using anaerobically prepared stool.

DESIGN, SETTING, AND PARTICIPANTS:

A total of 73 adults with mild to moderately active UC were enrolled in a multicenter, randomized, double-blind clinical trial in 3 Australian tertiary referral centers between June 2013 and June 2016, with 12-month follow-up until June 2017.

INTERVENTIONS:

Patients were randomized to receive either anaerobically prepared pooled donor FMT (n = 38) or autologous FMT (n = 35) via colonoscopy followed by 2 enemas over 7 days. Open-label therapy was offered to autologous FMT participants at 8 weeks and they were followed up for 12 months.

MAIN OUTCOMES AND MEASURES:

The primary outcome was steroid-free remission of UC, defined as a total Mayo score of ≤2 with an endoscopic Mayo score of 1 or less at week 8. Total Mayo score ranges from 0 to 12 (0 = no disease and 12 = most severe disease). Steroid-free remission of UC was reassessed at 12 months. Secondary clinical outcomes included adverse events.

RESULTS:

Among 73 patients who were randomized (mean age, 39 years; women, 33 [45%]), 69 (95%) completed the trial. The primary outcome was achieved in 12 of the 38 participants (32%) receiving pooled donor FMT compared with 3 of the 35 (9%) receiving autologous FMT (difference, 23% [95% CI, 4%-42%]; odds ratio, 5.0 [95% CI, 1.2-20.1]; P = .03). Five of the 12 participants (42%) who achieved the primary end point at week 8 following donor FMT maintained remission at 12 months. There were 3 serious adverse events in the donor FMT group and 2 in the autologous FMT group.

CONCLUSIONS AND RELEVANCE:

In this preliminary study of adults with mild to moderate UC, 1-week treatment with anaerobically prepared donor FMT compared with autologous FMT resulted in a higher likelihood of remission at 8 weeks. Further research is needed to assess longer-term maintenance of remission and safety.

 
Question posée
 
Quelle est l’efficacité de la Transplantation de Microbiote Fécale dans la RCH ?
 
Question posée
 
Par rapport à la TMF « autologue », la TMF « multi-donneurs » administrée par coloscopie (puis 2 lavements) a permis une rémission sans corticoïdes chez 32% des patients (vs 9%, P = 0,03). A un an, 42% des répondeurs étaient toujours en rémission.
 
Commentaires

Il s’agit d’une nouvelle étude positive de TMF dans la RCH. Les données commencent donc à s’accumuler et permettent de poursuivre les études. Reste à déterminer la place de la TMF dans la stratégie thérapeutique, les modalités d’utilisation sur le moyen/long terme, et le type de donneurs à privilégier.  

 
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