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

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.