Oral capsule and colonic administration both demonstrate similar advantages for C. difficile infection

Minnesota: In a prospective trial published in the Journal of Clinical Gastroenterology and Hepatology, fecal microbiota transplantation (FMT) administered through oral capsule or colonic administration showed comparable safety and efficacy for recurrent Clostridioides difficile infection (CDI).

In order to treat Clostridioides difficile infections (rCDI) that are repeatedly recurring and resistant to normal therapy, fecal microbiota transplantation (FMT) was developed. While the majority of rCDI patients have been excluded from placebo-controlled clinical trials because of medical co-morbidities, assessment of FMT efficacy differs among procedures and formulations.

"Management with oral capsules offers benefits of convenience of delivery, lack of a bowel purgative, and absence of colonoscopy associated dangers," they said. Contrarily, colonoscopic administration "delivers the bacteria into its designated compartment in the gut and permits diagnostic examination of the colonic mucosa."

In a sizable, multicentered, prospective real-world cohort, the authors wanted to assess the efficacy and safety of capsule FMT (cap-FMT) and colonoscopy FMT (colo-FMT) for rCDI using standardized materials.

Vaughn and associates used data from the American Gastroenterological Association's national patient registry for their investigation. A total of 269 patients with recurrent CDI were treated in six centers between July 2019 and October 2021 using formulations created by the University of Minnesota Microbiota Therapeutics Program through capsule (n=170) or colonoscopic FMT (n=96) (MTP).The treating physician chose the route of administration, and the FMT formulations were either oral, freeze-dried capsules (MTP-101C) or a frozen, thawed liquid suspension that had been preserved with glycerol for delivery during a colonoscopy (MTP-101LR).

Conclusive highlights:

• Recurrent CDI cure rates were 86% (95% CI 82-90) at 1 month and 81% (95% CI 75-86) at 2 months in the general population.
• Patients who experienced recurrences after their first FMT underwent repeat operations in 41% of cases (range: 2-4), and at two months, 82% of these patients were cured.
• The study's authors highlighted that adverse occurrences were comparable across groups and consistent with earlier publications.
• Constipation (12%), diarrhea (29% at 1 week), gas (22%), and bloating (15%) were among the prevalent changes in bowel habits.

However, Vaughn and colleagues pointed out that it can be challenging to distinguish between gastrointestinal symptoms associated with FMT and those of recurrent CDI.

The report claimed that FMT "effectively breaks the cycle" of recurrent CDI by restoring the host microbiota's variety and function, as opposed to antibiotic therapies, which "perpetuate and aggravate intestinal dysbiosis."

The authors concluded that the safety and effectiveness profile of cap-FMT, which uses freeze-dried capsules instead of a colonoscopy, is comparable to that of colo-FMT. Selection of patients is a crucial element in maximizing the success of FMT, despite being generally quite effective, the researchers added.

REFERENCE

Vaughn BP, et al "Effectiveness and safety of colonic and capsule fecal microbiota transplantation for recurrent Clostridioides difficile infection" Clin Gastroenterol Hepatol 2022; DOI: 10.1016/j.cgh.2022.09.008.