S843 Efficacy and Safety of Fecal Microbiota Transplantation in the Treatment of Active Inflammatory Bowel Disease - An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction: In active inflammatory bowel disease (IBD) patients refractory to standard medical therapy, fecal microbiota transplantation (FMT) has shown to be efficacious. The current literature presents compelling evidence for its use. Herein we performed an updated systematic review and meta-analysis to provide a more robust understanding of the effectiveness and safety of FMT on active IBD patients versus placebo. Methods: We performed a comprehensive literature search on multiple databases in May 2022. Only randomized controlled trials (RCTs) concerning active IBD patients treated with FMT versus placebo were included. Analysis was done using CMA software to compute Odds Ratio, 95% confidence interval. I2 was used to define heterogeneity. (Figure) Results: Ten RCTs with the desired study outcomes were included. We had a total of 437 patients in our study in which each patient met a baseline severity of their ulcerative colitis (UC) or Crohn’s Disease (CD) based on Mayo Score and Harvey Bradshaw Index respectively. Moreover improvement was standardized by the same scales. Our results are consistent with previous meta-analyses demonstrating reassuring efficacy of FMT in IBD patients when compared to placebo. Clinical (OR 1.506, (95% CI 1.259-1.803), P < 0.0001), endoscopic (OR 2.335, (95% CI 1.577-3.457), P < 0.0001), and histologic (OR 3.764, (95% CI 1.986-7.136), P < 0.001) remission were consistent with the aforementioned. Adverse events (OR 0.745, (95% CI 0.537-1.033), P = 0.077) in FMT patients were also as expected. (Table) Conclusion: FMT continues to demonstrates superior efficacy when compared to placebo in terms of active IBD treatment. Likewise, its adverse events compared to placebo display no statistical significance; equating to an analogous safety profile. Larger RCTs with longer follow up and more CD patients are necessary to strengthen the validity of FMT as an IBD therapeutic modality.Figure 1.: The clinical remission among active IBD patients treated with FMT versus placebo. Table 1. - Various outcomes of meta-analysis Outcomes Number of Studies OR & 95% CI P Value (I2) Clinical Remission 10 1.506 & 1.259-1.803 P < 0.001 Endoscopic Remission 6 2.335 & 1.577-3.457 P < 0.001 Histologic Remission 5 3.764 & 1.986-7.136 P < 0.001 Adverse Events 9 0.745 & 0.537-1.033 P = 0.077