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Article Dans Une Revue Microbiome Année : 2020

Fecal microbiota transplantation to maintain remission in Crohn’s disease: a pilot randomized controlled study

Cecilia Landman
  • Fonction : Auteur
Philippe Seksik
Laurence Berard
  • Fonction : Auteur
Mélissa Montil
  • Fonction : Auteur
Isabelle Nion-Larmurier
  • Fonction : Auteur
Anne Bourrier
  • Fonction : Auteur
Guillaume Le Gall
  • Fonction : Auteur
Valérie Lalande
  • Fonction : Auteur
Alexis de Rougemont
  • Fonction : Auteur
Julien Kirchgesner
Anne Daguenel
  • Fonction : Auteur
Marine Cachanado
Alexandra Rousseau
  • Fonction : Auteur
Élodie Drouet
  • Fonction : Auteur
Michelle Rosenzwajg
Hervé Hagege
  • Fonction : Auteur
Xavier Dray
  • Fonction : Auteur
David Klatzman
  • Fonction : Auteur
Philippe Marteau
  • Fonction : Auteur
Laurent Beaugerie
  • Fonction : Auteur
Tabassome Simon

Résumé

Background: The role of the gut microbiota in Crohn's disease (CD) is established and fecal microbiota transplantation (FMT) is an attractive therapeutic strategy. No randomized controlled clinical trial results are available. We performed a randomized, single-blind, sham-controlled pilot trial of FMT in adults with colonic or ileocolonic CD. Method: Patients enrolled while in flare received oral corticosteroid. Once in clinical remission, patients were randomized to receive either FMT or sham transplantation during a colonoscopy. Corticosteroids were tapered and a second colonoscopy was performed at week 6. The primary endpoint was the implantation of the donor microbiota at week 6 (Sorensen index > 0.6). Results: Eight patients received FMT and nine sham transplantation. None of the patients reached the primary endpoint. The steroid-free clinical remission rate at 10 and 24 weeks was 44.4% (4/9) and 33.3% (3/9) in the sham transplantation group and 87.5% (7/8) and 50.0% (4/8; one patient loss of follow-up while in remission at week 12 and considered in flare at week 24) in the FMT group. Crohn's Disease Endoscopic Index of Severity decreased 6 weeks after FMT (p = 0.03) but not after sham transplantation (p = 0.8). Conversely, the CRP level increased 6 weeks after sham transplantation (p = 0.008) but not after FMT (p = 0.5). Absence of donor microbiota engraftment was associated with flare. No safety signal was identified. Conclusion: The primary endpoint was not reached for any patient. In this pilot study, higher colonization by donor microbiota was associated with maintenance of remission. These results must be confirmed in larger studies (NCT02097797).
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Dates et versions

hal-03031236 , version 1 (30-11-2020)

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Harry Sokol, Cecilia Landman, Philippe Seksik, Laurence Berard, Mélissa Montil, et al.. Fecal microbiota transplantation to maintain remission in Crohn’s disease: a pilot randomized controlled study. Microbiome, 2020, 8 (12), ⟨10.1186/s40168-020-0792-5⟩. ⟨hal-03031236⟩
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