Single-Donor FMT Comparable to Multi-Donor FMT for Recurrent C Difficile

February 2, 2022
Kenny Walter

Kenny Walter is an editor with HCPLive. Prior to joining MJH Life Sciences in 2019, he worked as a digital reporter covering nanotechnology, life sciences, material science and more with R&D Magazine. He graduated with a degree in journalism from Temple University in 2008 and began his career as a local reporter for a chain of weekly newspapers based on the Jersey shore. When not working, he enjoys going to the beach and enjoying the shore in the summer and watching North Carolina Tar Heel basketball in the winter.

Both single-donor and multiple-donor fecal microbiota transplantation had clinical cure rates over 80%.

While multiple donor fecal microbiota transplantation (FMT) has shown efficacy in treating recurrent clostridium difficile infections (CDI), single-donor FMT is also showing comparable efficacy, according to a study that took place in Denmark.

A team, led by Frederik Cold, MD, Department of Gastroenterology, Aleris- Hamlet Hospitals, investigated the clinical efficacy of single-donor FMT and compared cure rates with previously reported cure rates of treatment with multi-donor FMT capsules produced at the same stool bank.

FMT

Fecal microbiota transplantation is a relatively new treatment that involves taking feces from healthy donors to rebuild the gut microbiota of a diseased individual. FMT is delivered through upper or lower endoscopy via enemas or capsules.

In recent years, FMT has emerged as an effective treatment for recurrent C difficile infections, with cure rates of 82-88%. In fact, FMT has shown more efficacy than the antibiotics commonly used to treat the infections.

FMT is considered a top treatment for recurrent CDI with evidence suggesting human metabolic profiles could be influenced by the treatment.

However, it is not entirely understood whether multi-donor or single donor FMT capsules impact cure rates.

Case Series

In the retrospective case series of patients, the investigators examined 18 patients with recurrent, refractory, or fulminant C difficile infections. Each patients was treated for 3 days with single-donor FMTcapsules between October and December 2020 in the capital region of Denmark.

The patients were aged between 22-87 years and had a median of 2 recurrences of C difficile infections.

The investigators defined clinical cure as the absence of diarrhea or diarrhea with C difficile negative stool samples 8 weeks following treatment.

Each patient with recurrent C difficile was pre-treated with oral vancomycin 125 mg and each patient with refractory or fulminant C difficile infection was treated with oral vancomycin 500 mg 4 times day for 7-10 days until 2 days before FMT treatment.

Overall, a clinical cure happened for 83.3% (n = 15) of patients following 3 days of FMT capsule treatments, with cure rates comparable (P = 1.0) to previously reported cure rates of 88.9% for multi-donor FMT capsule treatment of recurrent C difficile infections.

For safety, 7 patients were hospitalized in the 6 months following treatment, 1 of which due to the worsening of ulcerative colitis considered possibly related to the treatment. The other hospital admissions were deemed unrelated to the treatment, including the 2 deaths that occurred.

“Three days of single-donor FMT capsule treatment was effective and safe in the treatment of recurrent, refractory and fulminant C. difficile infection with cure rates comparable to those of multi-donor FMT capsule treatment,” the authors wrote. “The reported cure rates are in line with those reported in a recently published meta-analysis, including all studies investigating the effects of FMT capsules in recurrent C. difficile infection reporting a primary cure of 85%.”

The study, “Successful treatment of Clostridioides difficile infection with single-donor fecal microbiota transplantation capsules,” was published online in the Danish Medical Journal.


x