DELIVERY of faecal microbiota transplant (FMT) using capsules that contain freeze-dried microbiota confers similar efficacy and safety compared to liquid FMT delivery using a colonoscope when treating Clostridioides difficile infection (CDI), according to research from the University of Minnesota Medical School, Minneapolis, USA.
FMT is a treatment method utilised to reintroduce a healthy gut microbiota to individuals with intestinal damage as a result of CDI secondary to antibiotic use, that is refractory to standard medical therapy. It works by enabling repair of the intestinal damage and reinstating resistance to C. difficile. Conventionally, FMT is delivered using a liquid preparation via a colonoscope; however, there are complications associated with this invasive procedure.
To address this, with support from Achieving Cures Together, a non-profit organisation focused on microbiome research, the researchers conducted a multicentre, national prospective study, where a total of 301 FMTs were performed across 269 patients. Of the 301 FMTs, one-third were delivered by colonoscope, and two-thirds were delivered orally using capsules containing freeze-dried microbes.
The authors revealed that there was no difference in CDI cure rates between capsule-delivered and colonoscope-delivered FMT at 1- and 2-month follow-ups. Overall, 1-month and 2-month cure rates using capsule-delivered FMT were similar to that for colonoscope-delivered FMT at 86% and 81%, respectively. Moreover, the researchers did not report any additional safety concerns.
Whilst this study reported similar safety and efficacy in cure rates for CDI, capsule-FMT does not carry the risks associated with the colonoscopy procedure itself. However, the team commented that lower cure rates were seen amongst patients who received post-FMT antibiotics, were on haemodialysis, or were older in age, and, therefore, highlighted how patient selection is crucial in optimising FMT outcomes. Looking forward, further research to understand the mechanisms behind FMT failure is required to help improve patient selection and optimise outcomes.