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Faecal microbiota transplantation for recurrent Clostridioides difficile infection: an updated systematic review and meta-analysis

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Title: Faecal microbiota transplantation for recurrent Clostridioides difficile infection: an updated systematic review and meta-analysis
Authors: Baunwall, SMD
Lee, MM
Eriksen, MK
Mullish, BH
Marchesi, JR
Dahlerup, JF
Hvas, CL
Item Type: Journal Article
Abstract: Background Faecal microbiota transplantation (FMT) is effective for recurrent Clostridioides difficile infection (CDI), but inconsistent effect rates and uncertain evidence levels have warranted caution. To clarify, we aimed to establish the evidence of FMT for recurrent CDI, updated across different delivery methods, treatment regimens, and in comparison with standard antibiotics. Methods In this updated systematic review and meta-analysis, we searched PubMed, Scopus, Embase, Web of Science, Clinical Key, and Svemed+ for FMT literature published in English until November 11, 2019. We included observational and clinical trials with or without antibiotic comparators and excluded studies with below 8 weeks follow-up and fewer than 15 patients. The primary outcome was clinical outcome by week 8. We comprehensively extracted patient and procedural data. In a random-effects meta-analysis, we estimated the clinical effect for repeat or single FMT, different delivery methods, and versus antibiotics. We rated the evidence according to the Cochrane and GRADE methods. The PROSPERO preregistration number is CRD42020158112. Findings Of 1816 studies assessed, 45 studies were included. The overall clinical effect week 8 following repeat FMT (24 studies, 1855 patients) was 91% (95% CI: 89–94%, I2=53%) and 84% (80–88%, I2=86%) following single FMT (43 studies, 2937 patients). Delivery by lower gastrointestinal endoscopy was superior to all other delivery methods, and repeat FMT significantly increased the treatment effect week 8 (P<0·001). Compared with vancomycin, the number needed to treat (NNT) for repeat FMT was 1·5 (1·3–1·9, P<0·001) and 2.9 (1·5–37·1, P=0·03) for single FMT. Repeat FMT had high quality of evidence. Interpretation High-quality evidence supports FMT is effective for recurrent CDI, but its effect varies with the delivery method and the number of administrations. The superior NNT for FMT compared with antibiotics suggests that patients may benefit from advancing FMT to all instances of recurrent CDI. Funding Innovation Fund Denmark (j.no. 8056-00006B).
Issue Date: Dec-2020
Date of Acceptance: 6-Nov-2020
URI: http://hdl.handle.net/10044/1/85051
DOI: 10.1016/j.eclinm.2020.100642
ISSN: 2589-5370
Publisher: Elsevier
Start Page: 1
End Page: 12
Journal / Book Title: EClinicalMedicine
Volume: 29-30
Copyright Statement: © 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RDA02
Keywords: CDAD, CD associated diarrhoea
CDI
CDI, Clostridioides difficile infection
CI, Confidence interval
Clostridioides difficile
Clostridioides difficile infection
FMT
FMT, Faecal microbiota transplantation
Fecal microbiota transplantation
GI, Gastrointestinal
Meta-analysis
NA, Not available
NOS, Newcastle-Ottawa quality assessment Scale
Number needed to treat
Number needed to treat, NNT
PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis
RR, Relative risk
Randomised clinical trial, RCT
RoB2, Cochrane Risk of Bias 2
Systematic review
Publication Status: Published
Online Publication Date: 2020-11-23
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine



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