Fecal microbiota transplantation (FMT) for patients with ulcerative colitis (UC) has shown mixed clinical results (see recent trials here and here). In a new pilot study, published as open access, Faming Zhang and colleagues tested the safety and efficacy of a “step-up” FMT strategy in 15 steroid-dependent UC patients.
The step-up strategy was as follows: After all medications were discontinued, (1) patients received an initial FMT treatment; (2) patients who did not benefit from step 1 received a second FMT treatment one week later; and (3) patients who did not improve after steps 1 and 2 were switched to a short course of steroid therapy alone. Patients could opt out, resuming steroid therapy or switching to biologic therapy, at any time.
After applying the step-up FMT strategy, researchers found that 57% of the patients showed clinical improvement and discontinued steroid treatment. The gut microbiota composition of the FMT responders became similar to that of the donor, and half of the responders maintained remission up to 18 months. The remaining patients in the study did not show clinical improvement and remained dependent on steroid medication.
Below, Faming Zhang answers some questions about the study for GMFH editors.
Why did you want to investigate how potential UC treatments (here, steroid medication and FMT) can work together?
The idea of the step-up FMT strategy originated from our observation of one case who failed to FMT, but then benefited from the following steroid treatment. Therefore, we had the hypothesis that [a] combination of two FMTs followed by steroids might lead to better results.
Did you note any differences between patients who responded at step 1, those who responded at step 2, and those who responded at step 3?
This is a tough question. Actually, we did not know the differences. However, if the patients [in] the steroid-dependent situation failed to respond to the first FMT, they would have a high possibility of needing steroids in the following treatment.
You gave informal dietary recommendations to the patients. Do you think diet played a role in the success of this strategy?
The management of diet appeared very important for reducing the risk of flare. Though some cases maintained the remission after FMT, strict requirement on the diet should [probably] be introduced. Some patients may have difficulty controlling diet, so enough medical education for patients has to be given.
Reference: Cui B, et al. (2015) Step-up fecal microbiota transplantation strategy: a pilot study for steroid-dependent ulcerative colitis. Journal of Translational Medicine DOI:10.1186/s12967-015-0646-2