IDDF2023-ABS-0160 Fecal microbiota transplantation in patients with mild to moderate ulcerative colitis is associated with early clinical response in a real-world setting

Background

Fecal microbial transplantation (FMT) is efficacious in patients with ulcerative colitis (UC). There is a large knowledge gap in the number of FMT sessions required for the response and timing of the response to FMT.

Methods

In this open-label, single-center (All India Institute of Medical Sciences, New Delhi, 2019-2022) study, patients with mild-moderate UC who were refractory to conventional therapy were subjected to FMT. Patients received up to 7 sessions of freshly prepared FMT once a week, administered colonoscopically. Clinical assessment using SCCAI (simple clinical colitis activity index) was done at each follow-up FMT session for 8 weeks. Clinical remission is defined as SCCAI ≤ 3 and response as the decrease in SCCAI scores by 3 points.

Results

Forty-one patients of active UC (mean age 33.9±11.05 years, 61% males, the median duration of disease 48 months, 63.4% left side colitis, 36.6% pancolitis, median SCCAI at baseline 6) were included, of which 26 (63.4%) had a clinical response, and 23 (56%) had clinical remission at week 8 (IDDF2023-ABS-0160 Table 1). Twenty patients (48.8%) were early responders, with the median time to achieve clinical response as early as 1 week. There was no significant difference in baseline demographic, clinical, endoscopic and laboratory features between responders and non-responders at week 1. There was a significant improvement in PRO (patient-reported outcome) scores (IDDF2023-ABS-0160 Figure 2. Improvement in weekly mean PRO total scores of patients who had clinical response at 8 weeks) at week 1, correlating the early clinical response (IDDF2023-ABS-0160 Figure 1. Reduction in weekly mean SCCAI scores of patients who had clinical response at 8 weeks).

Conclusions

Half of the patients with mild to moderate UC refractory to conventional therapy achieved clinical response on FMT as early as 1 week. Studies including a large number of patients are required to assess the predictors of early response including the microbiota characteristics.