Chapon Julia, Scanzi Julien, Sokol Harry, Pereira Bruno, Buisson Anthony
Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.
Centre Hospitalier de Thiers, Thiers, France.
Therap Adv Gastroenterol. 2025 Aug 25;18:17562848251369624. doi: 10.1177/17562848251369624. eCollection 2025.
BACKGROUND: While several small sample size randomized controlled trials suggested the superiority of faecal microbiota transplantation (FMT) over placebo in ulcerative colitis (UC), the most effective modality to perform FMT remains unknown. OBJECTIVES: To compare the efficacy of different modalities of FMT to induce clinical remission in patients with UC. DATA SOURCES AND METHODS: We performed a systematic review and network analysis (sources: MEDLINE, Embase, Cochrane CENTRAL; random effects model) of randomized controlled trials including at least one arm of FMT in adult patients with active UC. The primary endpoint, that is, clinical remission (total Mayo score ⩽2 with Mayo endoscopic score ⩽1), was assessed between weeks 6 and 12. Results are expressed as relative risks with 95% confidence intervals, adjusted for bowel cleansing and pre-FMT antibiotics. Ranking of FMT modalities was calculated as their surface under the cumulative ranking (SUCRA). RESULTS: Among the 12 selected studies, patients were exclusively bio-naïve in 4 studies (4/12), while between 9% and 32% had prior biologics exposure in the other trials. The risk of bias was low across all domains in seven studies. Contrary to upper gastrointestinal tract (GI) FMT (Relative risk (RR) = 1.1 (0.2-7.7)), oral capsule (RR = 7.1 (1.8-33.3)), lower GI FMT (RR = 4.5 (1.7-12.5) and combination of both (RR = 12.5 (2.1-100)) are more effective than placebo to induce clinical remission. The combination of lower GI FMT and oral capsule was significantly more effective than upper GI FMT to induce clinical remission (RR = 10.7 (1.1-104.2)). Combination of lower GI FMT and oral capsule ranked the highest for the induction of clinical remission (SUCRA = 0.93). Multidonor FMT did not perform better than single donor FMT. Autologous FMT ranked lower than placebo (SUCRA = 0.12 vs 0.22). CONCLUSION: The combination of lower GI and oral capsule FMT seems to be the best modality of FMT for patients with UC. In clinical trials, autologous FMT should be avoided due to a potential detrimental effect. TRIAL REGISTRATION: PROSPERO registration number: CRD42023385511.
背景：虽然几项小样本随机对照试验表明，粪便微生物群移植（FMT）在溃疡性结肠炎（UC）中优于安慰剂，但进行FMT的最有效方式仍不清楚。 目的：比较不同方式的FMT诱导UC患者临床缓解的疗效。 数据来源和方法：我们对随机对照试验进行了系统评价和网络分析（来源：MEDLINE、Embase、Cochrane CENTRAL；随机效应模型），纳入了至少有一组FMT治疗的成年活动性UC患者。主要终点，即临床缓解（梅奥总评分≤2且梅奥内镜评分≤1），在第6至12周进行评估。结果以相对风险及95%置信区间表示，并对肠道清洁和FMT前使用抗生素进行了校正。FMT方式的排名根据其累积排名曲线下面积（SUCRA）计算。 结果：在12项入选研究中，4项研究（4/12）的患者完全未接触过生物制剂，而在其他试验中，9%至32%的患者曾接触过生物制剂。7项研究在所有领域的偏倚风险均较低。与上消化道（GI）FMT（相对风险（RR）=1.1（0.2 - 7.7））相反，口服胶囊（RR = 7.1（1.8 - 33.3））、下消化道GI FMT（RR = 4.5（1.7 - 12.5））以及两者联合（RR = 12.5（2.1 - 100））在诱导临床缓解方面比安慰剂更有效。下消化道GI FMT与口服胶囊联合在诱导临床缓解方面显著优于上消化道GI FMT（RR = 10.7（1.1 - 104.2））。下消化道GI FMT与口服胶囊联合在诱导临床缓解方面排名最高（SUCRA = 0.93）。多供体FMT并不比单供体FMT效果更好。自体FMT的排名低于安慰剂（SUCRA = 0.12对0.22）。 结论：下消化道与口服胶囊联合的FMT似乎是UC患者FMT的最佳方式。在临床试验中，由于可能存在有害影响，应避免使用自体FMT。 试验注册：PROSPERO注册号：CRD42023385511。
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