Systematic Review: The association between the gut microbiota and medical therapies in inflammatory bowel disease

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Title: Systematic Review: The association between the gut microbiota and medical therapies in inflammatory bowel disease
Authors: Radhakrishnan, ST
Alexander, JL
Mullish, BH
Gallagher, KI
Powell, N
Hicks, LC
Hart, AL
Li, JV
Marchesi, JR
Williams, HRT
Item Type: Journal Article
Abstract: Background The gut microbiota has been implicated in the pathogenesis of inflammatory bowel disease (IBD), with Faecalibacterium prausnitizii associated with protection, and certain genera (including Shigella and Escherichia) associated with adverse features. The variability of patient response to medical therapies in IBD is incompletely understood. Given the recognised contribution of the microbiota to treatment efficacy in other conditions, there may be interplay between the gut microbiota, IBD medical therapy and IBD phenotype. Aims To evaluate the bidirectional relationship between IBD medical therapies and the gut microbiota. Methods We conducted a systematic search of MEDLINE and EMBASE. All original studies analysing interactions between the gut microbiota and established IBD medical therapies were included. Results We screened 1296 records; 19 studies were eligible. There was heterogeneity in terms of sample analysis, treatment protocols, and outcome reporting. Increased baseline α-diversity was observed in responders versus non-responders treated with exclusive enteral nutrition (EEN), infliximab, ustekinumab or vedolizumab. Higher baseline Faecalibacterium predicted response to infliximab and ustekinumab. A post-treatment increase in Faecalibacterium prausnitzii was noted in responders to aminosalicylates, anti-TNF medications and ustekinumab; conversely, this species decreased in responders to EEN. Escherichia was a consistent marker of unfavourable drug response, and its presence in the gut mucosa correlated with inflammation in aminosalicylate-treated patients. Conclusions Both gut microbiota diversity and specific taxonomic features (including high abundance of Faecalibacterium) are associated with the efficacy of a range of IBD therapies. These findings hold promise for a potential role for the gut microbiota in explaining the heterogeneity of patient response to IBD treatments.
Issue Date: Jan-2022
Date of Acceptance: 6-Oct-2021
DOI: 10.1111/apt.16656
ISSN: 0269-2813
Publisher: Wiley
Start Page: 26
End Page: 48
Journal / Book Title: Alimentary Pharmacology and Therapeutics
Volume: 55
Issue: 1
Copyright Statement: © 2021 John Wiley & Sons Ltd. This is the accepted version of the following article: Radhakrishnan, ST, Alexander, JL, Mullish, BH, et al. Systematic review: the association between the gut microbiota and medical therapies in inflammatory bowel disease. Aliment Pharmacol Ther. 2021; 00: 1– 23, which has been published in final form at
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RDA02
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Pharmacology & Pharmacy
Gastroenterology & Hepatology
1103 Clinical Sciences
1115 Pharmacology and Pharmaceutical Sciences
Publication Status: Published
Embargo Date: 2022-11-08
Online Publication Date: 2021-11-09
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine