A Network Meta-analysis of Randomized Controlled Trials Exploring the Role of Fecal Microbiota Transplantation in Recurrent Infection

Overview

Journal United European Gastroenterol J

Publisher Wiley

Specialty Gastroenterology

Date 2019 Oct 31

PMID 31662862

Citations 27

Authors

Theodore Rokkas

Javier P Gisbert

Antonio Gasbarrini

Georgina L Hold

Herbert Tilg

Peter Malfertheiner

Francis Megraud

Colm OMorain

Affiliations

Soon will be listed here.

Abstract

Background: Recurrence remains a challenge in infection (CDI), and in this field fecal microbiota transplantation (FMT) has attracted significant interest. Network meta-analysis (NWM) has been established as an evidence-synthesis tool that incorporates direct and indirect evidence in a collection of randomized controlled trials. So far no NWM exists concerning therapeutic interventions for recurrent CDI (rCDI).

Objective: In this NWM we assessed the comparative effectiveness of various therapies for rCDI to examine the efficacy rank order and determine the optimum therapeutic approach.

Methods: A Bayesian network meta-analysis was performed to investigate the efficacy rank order of rCDI interventions.

Results: Six eligible RCTs were entered into an NWM. They included 348 rCDI patients, in whom seven therapeutic interventions were used, i.e. donor fecal microbiota transplantation (DFMT), vancomycin, fidaxomicin, vancomycin + DFMT, vancomycin + bowel lavage, autologous FMT and placebo. DFMT showed the highest efficacy in comparison with vancomycin [odds ratio (95% credible interval), 20.02 (7.05-70.03)] and fidaxomicin (22.01 (4.38-109.63)).

Conclusion: This NWM showed that DFMT is the optimum therapeutic approach for rCDI, as it was the most efficacious among various therapeutic interventions, particularly in comparison with commonly used antibiotics such as vancomycin or fidaxomicin.

Citing Articles

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