Older patients benefit more from sequential courses of washed microbiota transplantation than younger population with ulcerative colitis

Abstract

Objectives

The short-term efficacy of fecal microbiota transplantation (FMT) for ulcerative colitis (UC) has increasingly been evaluated. However, few studies have examined the long-term efficacy and its predictors. This study aimed to assess the clinical factors affecting the long-term efficacy of FMT for patients with UC.

Methods

This is a retrospective analysis of a prospective trial (NCT01790061) for patients with UC undergoing washed microbiota transplantation (WMT), which is the improved methodology of FMT. The long-term clinical efficacy of WMT and the factors affecting efficacy were analyzed.

Results

A total of 259 patients were included for analysis. Of 70.7% (183/259) of patients achieved a clinical response at 1 month after WMT and 29.7% (77/259) achieved steroid-free clinical remission 6 months after WMT. Total 44 patients maintained a clinical response for ≥24 months, and 33 (17.1%, 33/193) achieved steroid-free clinical remission for ≥24 months with WMT monotherapy. Patients with age at UC onset of ≥60 years, mild disease severity and undergoing ≥2 courses of WMT during the response within 6 months were more likely to achieve steroid-free clinical remission 6 months after WMT. Besides, independent factors associated with the long-term response of WMT for UC were age at onset of ≥60 years and ≥2 courses of WMT during the response.

Conclusions

This study indicated WMT could induce short-term steroid-free clinical remission and maintain long-term response in UC, especially for older patients and patients undergoing sequential courses.

Keywords:

• Fecal microbiota transplant
• washed microbiota transplantation
• ulcerative colitis
• transendoscopic enteral tube
• efficacy
• microbiome
• ageing
• microbiota medicine

View correction statement:

Correction

Correction Statement

This article was originally published with errors, which have now been corrected in the online version. Please see Correction (https://doi.org/10.1080/00365521.2023.2190630).

Acknowledgments

The authors express their appreciation for all those who participated in the study and for the kind help of Jie Zhang, Yaoyao Chen and Lixia Xiong, who provided data from the China Microbiota Transplantation System.

Ethical approval

The study was approved by the research ethics committees at the Second Affiliated Hospital of Nanjing Medical University ([2012]KY015) and was registered at clinicaltrials.gov (NCT01790061).

Author contributions

Y.L. and X.J. designed the study, analyzed data and wrote the manuscript. Y.L., X.J., Y.H., Q.L., X.D., Y.W., S.Z., Q.W., B.C. and F.Z. were responsible for the recruitment and treatment of the patients and participated the data collection. Y.H., Q.L., Y.W., S.Z. and F. Z. revised the manuscript. F.Z. and X.L. made substantial contributions to the conception of the present study and had grants support. All authors read and approved the final manuscript.

Disclosure statement

F.Z. conceived the concepts of GenFMTer and TET and devices related to them. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the National Key Research and Development Programme of China [2021YFA0717000], National Natural Science Foundation of China [81670495, 81600417], China National Center for Clinical Research of Digestive Diseases [2015BAI13B07], Nanjing Medical University Fan Daiming Research Funds for Holistic Integrative Medicine and publically donated grants from Intestine Initiative.