MaaT Pharma, Lyon, France.
Questel Consulting, Grenoble, France.
Clin Transl Gastroenterol. 2023 May 1;14(5):e00568. doi: 10.14309/ctg.0000000000000568.
Patients with ulcerative colitis (UC) have a less diverse microbiome than healthy subjects. Multiple studies have evaluated fecal microbiota transfer (FMT) in these patients using different methods of product preparation, doses, and routes of administration. A systematic review and meta-analysis was performed to compare the efficacy of single-donor (SDN) and multidonor (MDN) strategies for product preparation.
Systematic searches were performed in Web of Science, Scopus, PubMed, and Orbit Intelligence for studies comparing FMT products manufactured using SDN or MDN strategies to placebo in patients with UC. Fourteen controlled studies were selected for meta-analysis (10 randomized and 4 nonrandomized). The treatment response was assessed by using fixed- and random-effects models, and the significance of the indirect difference between the interventions was assessed using a network approach.
Considering all 14 studies, MDN and SDN were superior to placebo in terms of treatment response (risk ratios [RRs]: 4.41 and 1.57, respectively [P ≤ 0.001 for both]), and MDN was superior to SDN (RR: 2.81, P = 0.005). Meta-analysis of the 10 studies with high quality of evidence showed that MDN was superior to SDN in terms of treatment response (RR: 2.31, P = 0.042). Results were identical for both models.
There was a significant clinical benefit (remission) for patients with UC who received FMT with products manufactured by MDN strategies. Reduction of donor effect may lead to a gain in microbial diversity that could improve response to treatment. These results may have implications in the treatment approach of other diseases amenable to microbiome manipulation.JOURNAL/cltg/04.03/01720094-202305000-00002/2FFU1/v/2023-05-23T220055Z/r/image-tiff.
溃疡性结肠炎（UC）患者的微生物组多样性低于健康受试者。多项研究采用不同的产品制备方法、剂量和给药途径，评估了这些患者的粪便微生物群移植（FMT）。进行了系统评价和荟萃分析，以比较单供体（SDN）和多供体（MDN）策略在产品制备方面的疗效。
在 Web of Science、Scopus、PubMed 和 Orbit Intelligence 中系统地搜索了比较 UC 患者使用 SDN 或 MDN 策略制备的 FMT 产品与安慰剂的疗效的研究。选择了 14 项对照研究进行荟萃分析（10 项随机对照研究和 4 项非随机对照研究）。采用固定效应和随机效应模型评估治疗反应，采用网络方法评估干预措施之间间接差异的显著性。
考虑到所有 14 项研究，MDN 和 SDN 在治疗反应方面均优于安慰剂（风险比 [RR]：4.41 和 1.57，均 P≤0.001），MDN 优于 SDN（RR：2.81，P=0.005）。对 10 项高质量证据研究的荟萃分析表明，MDN 在治疗反应方面优于 SDN（RR：2.31，P=0.042）。两种模型的结果均相同。
接受 MDN 策略制备的 FMT 产品治疗的 UC 患者有显著的临床获益（缓解）。减少供体效应可能会导致微生物多样性增加，从而改善治疗反应。这些结果可能对其他可通过微生物组操作治疗的疾病的治疗方法有影响。
