Upper versus lower gastrointestinal delivery for transplantation of fecal microbiota in recurrent or refractory clostridium difficile infection: A collaborative analysis of individual patient data from 14 studies

Luis Furuya-Kanamori, Suhail A R Doi, David L. Paterson, Stefan K Helms, Laith Yakob, Samantha J McKenzie, Kjetil Garborg, Frida Emanuelsson, Neil Stollman, Matthew P Kronman, Justin Clark, Charlotte A Huber, Thomas V Riley, Archie C Clements

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Abstract

GOALS: The aim of this study was to compare upper gastrointestinal (UGI) versus lower gastrointestinal (LGI) delivery routes of fecal microbiota transplantation (FMT) for refractory or recurrent/relapsing Clostridium difficile infection (CDI).

BACKGROUND: FMT has been proven to be a safe and highly effective therapeutic option for CDI. Delivery, however, could be via the UGI or LGI routes, and it is unclear as to which route provides better clinical outcome.

STUDY: A systematic search for studies that reported the use of FMT for CDI treatment was conducted. Individual patient data that included demographic (age and sex) and clinical (route of FMT delivery, CDI outcome after FMT, and follow-up time) information were obtained. Kaplan-Meier cumulative hazard curves and Cox proportional hazard models were used to assess clinical failure after FMT by the route of delivery.

RESULTS: Data from 305 patients treated with FMT (208 via LGI route and 97 via UGI route) for CDI were analyzed. At 30 and 90 days, the risk of clinical failure was 5.6% and 17.9% in the UGI group compared with 4.9% and 8.5% in the LGI delivery route group, respectively. A time-varying analysis suggested a 3-fold increase in hazard of clinical failure for UGI delivery (hazard ratio, 3.43; 95% confidence interval, 1.32-8.93) in the period after 30 days.

CONCLUSIONS: FMT delivered via the LGI seems to be the most effective route for the prevention of recurrence/relapse of CDI. A randomized controlled trial is necessary to confirm whether FMT delivered via the LGI is indeed superior to that delivered via the UGI route.

Original languageEnglish
Pages (from-to)145-150
Number of pages6
JournalJournal of Clinical Gastroenterology
Volume51
Issue number2
DOIs
Publication statusPublished - Feb 2017

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Clostridium Infections
Clostridium difficile
Fecal Microbiota Transplantation
Secondary Prevention
Proportional Hazards Models
Randomized Controlled Trials
Demography
Confidence Intervals
Recurrence

Cite this

Furuya-Kanamori, Luis ; Doi, Suhail A R ; Paterson, David L. ; Helms, Stefan K ; Yakob, Laith ; McKenzie, Samantha J ; Garborg, Kjetil ; Emanuelsson, Frida ; Stollman, Neil ; Kronman, Matthew P ; Clark, Justin ; Huber, Charlotte A ; Riley, Thomas V ; Clements, Archie C. / Upper versus lower gastrointestinal delivery for transplantation of fecal microbiota in recurrent or refractory clostridium difficile infection : A collaborative analysis of individual patient data from 14 studies. In: Journal of Clinical Gastroenterology. 2017 ; Vol. 51, No. 2. pp. 145-150.
@article{45d9b43456af421fbc0a063aa78b2e04,
title = "Upper versus lower gastrointestinal delivery for transplantation of fecal microbiota in recurrent or refractory clostridium difficile infection: A collaborative analysis of individual patient data from 14 studies",
abstract = "GOALS: The aim of this study was to compare upper gastrointestinal (UGI) versus lower gastrointestinal (LGI) delivery routes of fecal microbiota transplantation (FMT) for refractory or recurrent/relapsing Clostridium difficile infection (CDI).BACKGROUND: FMT has been proven to be a safe and highly effective therapeutic option for CDI. Delivery, however, could be via the UGI or LGI routes, and it is unclear as to which route provides better clinical outcome.STUDY: A systematic search for studies that reported the use of FMT for CDI treatment was conducted. Individual patient data that included demographic (age and sex) and clinical (route of FMT delivery, CDI outcome after FMT, and follow-up time) information were obtained. Kaplan-Meier cumulative hazard curves and Cox proportional hazard models were used to assess clinical failure after FMT by the route of delivery.RESULTS: Data from 305 patients treated with FMT (208 via LGI route and 97 via UGI route) for CDI were analyzed. At 30 and 90 days, the risk of clinical failure was 5.6{\%} and 17.9{\%} in the UGI group compared with 4.9{\%} and 8.5{\%} in the LGI delivery route group, respectively. A time-varying analysis suggested a 3-fold increase in hazard of clinical failure for UGI delivery (hazard ratio, 3.43; 95{\%} confidence interval, 1.32-8.93) in the period after 30 days.CONCLUSIONS: FMT delivered via the LGI seems to be the most effective route for the prevention of recurrence/relapse of CDI. A randomized controlled trial is necessary to confirm whether FMT delivered via the LGI is indeed superior to that delivered via the UGI route.",
author = "Luis Furuya-Kanamori and Doi, {Suhail A R} and Paterson, {David L.} and Helms, {Stefan K} and Laith Yakob and McKenzie, {Samantha J} and Kjetil Garborg and Frida Emanuelsson and Neil Stollman and Kronman, {Matthew P} and Justin Clark and Huber, {Charlotte A} and Riley, {Thomas V} and Clements, {Archie C}",
year = "2017",
month = "2",
doi = "10.1097/MCG.0000000000000511",
language = "English",
volume = "51",
pages = "145--150",
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Furuya-Kanamori, L, Doi, SAR, Paterson, DL, Helms, SK, Yakob, L, McKenzie, SJ, Garborg, K, Emanuelsson, F, Stollman, N, Kronman, MP, Clark, J, Huber, CA, Riley, TV & Clements, AC 2017, 'Upper versus lower gastrointestinal delivery for transplantation of fecal microbiota in recurrent or refractory clostridium difficile infection: A collaborative analysis of individual patient data from 14 studies' Journal of Clinical Gastroenterology, vol. 51, no. 2, pp. 145-150. https://doi.org/10.1097/MCG.0000000000000511

Upper versus lower gastrointestinal delivery for transplantation of fecal microbiota in recurrent or refractory clostridium difficile infection : A collaborative analysis of individual patient data from 14 studies. / Furuya-Kanamori, Luis; Doi, Suhail A R; Paterson, David L.; Helms, Stefan K; Yakob, Laith; McKenzie, Samantha J; Garborg, Kjetil; Emanuelsson, Frida; Stollman, Neil; Kronman, Matthew P; Clark, Justin; Huber, Charlotte A; Riley, Thomas V; Clements, Archie C.

In: Journal of Clinical Gastroenterology, Vol. 51, No. 2, 02.2017, p. 145-150.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Upper versus lower gastrointestinal delivery for transplantation of fecal microbiota in recurrent or refractory clostridium difficile infection

T2 - A collaborative analysis of individual patient data from 14 studies

AU - Furuya-Kanamori, Luis

AU - Doi, Suhail A R

AU - Paterson, David L.

AU - Helms, Stefan K

AU - Yakob, Laith

AU - McKenzie, Samantha J

AU - Garborg, Kjetil

AU - Emanuelsson, Frida

AU - Stollman, Neil

AU - Kronman, Matthew P

AU - Clark, Justin

AU - Huber, Charlotte A

AU - Riley, Thomas V

AU - Clements, Archie C

PY - 2017/2

Y1 - 2017/2

N2 - GOALS: The aim of this study was to compare upper gastrointestinal (UGI) versus lower gastrointestinal (LGI) delivery routes of fecal microbiota transplantation (FMT) for refractory or recurrent/relapsing Clostridium difficile infection (CDI).BACKGROUND: FMT has been proven to be a safe and highly effective therapeutic option for CDI. Delivery, however, could be via the UGI or LGI routes, and it is unclear as to which route provides better clinical outcome.STUDY: A systematic search for studies that reported the use of FMT for CDI treatment was conducted. Individual patient data that included demographic (age and sex) and clinical (route of FMT delivery, CDI outcome after FMT, and follow-up time) information were obtained. Kaplan-Meier cumulative hazard curves and Cox proportional hazard models were used to assess clinical failure after FMT by the route of delivery.RESULTS: Data from 305 patients treated with FMT (208 via LGI route and 97 via UGI route) for CDI were analyzed. At 30 and 90 days, the risk of clinical failure was 5.6% and 17.9% in the UGI group compared with 4.9% and 8.5% in the LGI delivery route group, respectively. A time-varying analysis suggested a 3-fold increase in hazard of clinical failure for UGI delivery (hazard ratio, 3.43; 95% confidence interval, 1.32-8.93) in the period after 30 days.CONCLUSIONS: FMT delivered via the LGI seems to be the most effective route for the prevention of recurrence/relapse of CDI. A randomized controlled trial is necessary to confirm whether FMT delivered via the LGI is indeed superior to that delivered via the UGI route.

AB - GOALS: The aim of this study was to compare upper gastrointestinal (UGI) versus lower gastrointestinal (LGI) delivery routes of fecal microbiota transplantation (FMT) for refractory or recurrent/relapsing Clostridium difficile infection (CDI).BACKGROUND: FMT has been proven to be a safe and highly effective therapeutic option for CDI. Delivery, however, could be via the UGI or LGI routes, and it is unclear as to which route provides better clinical outcome.STUDY: A systematic search for studies that reported the use of FMT for CDI treatment was conducted. Individual patient data that included demographic (age and sex) and clinical (route of FMT delivery, CDI outcome after FMT, and follow-up time) information were obtained. Kaplan-Meier cumulative hazard curves and Cox proportional hazard models were used to assess clinical failure after FMT by the route of delivery.RESULTS: Data from 305 patients treated with FMT (208 via LGI route and 97 via UGI route) for CDI were analyzed. At 30 and 90 days, the risk of clinical failure was 5.6% and 17.9% in the UGI group compared with 4.9% and 8.5% in the LGI delivery route group, respectively. A time-varying analysis suggested a 3-fold increase in hazard of clinical failure for UGI delivery (hazard ratio, 3.43; 95% confidence interval, 1.32-8.93) in the period after 30 days.CONCLUSIONS: FMT delivered via the LGI seems to be the most effective route for the prevention of recurrence/relapse of CDI. A randomized controlled trial is necessary to confirm whether FMT delivered via the LGI is indeed superior to that delivered via the UGI route.

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U2 - 10.1097/MCG.0000000000000511

DO - 10.1097/MCG.0000000000000511

M3 - Article

VL - 51

SP - 145

EP - 150

JO - Journal of Clinical Gastroenterology

JF - Journal of Clinical Gastroenterology

SN - 0192-0790

IS - 2

ER -