Safety and preliminary efficacy of orally administered lyophilized fecal microbiota product compared with frozen product given by enema for recurrent Clostridium difficile infection: A randomized clinical trial

• Published in: PloS one Vol. 13; no. 11; p. e0205064
• Main Authors: Jiang, Zhi-Dong, Jenq, Robert R., Ajami, Nadim J., Petrosino, Joseph F., Alexander, Ashley A., Ke, Shi, Iqbal, Tehseen, DuPont, Andrew W., Muldrew, Kenneth, Shi, Yushu, Peterson, Christine, Do, Kim-Anh, DuPont, Herbert L.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.11.2018; Public Library of Science (PLoS)
• Subjects: Administration, Oral; Adult; Adults; Aged; Aged, 80 and over; Analysis; Antibiotics; Bacteria; Biology and Life Sciences; Cancer; Capsules; Care and treatment; Clinical trials; Clostridium difficile - isolation & purification; Clostridium infections; Clostridium Infections - therapy; Colon; Colonoscopy; Comparative analysis; Cryopreservation; Effectiveness; Enema; Enema - adverse effects; Enema - methods; Epidemiology; Fecal Microbiota Transplantation - adverse effects; Fecal Microbiota Transplantation - methods; Fecal microflora; Feces; Female; Freeze Drying; Health care; Humans; Infections; Infectious diseases; Male; Medicine and Health Sciences; Microbiomes; Microbiota; Middle Aged; Oral administration; Pathogens; Product safety; Public health; Rectum; Recurrent infection; Safety; Spore-forming bacteria; Transplantation; Transplants & implants; Treatment outcome; Virology; Young Adult; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0205064

Fecal microbiota transplantation (FMT) via colonoscopy or enema has become a commonly used treatment of recurrent C. difficile infection (CDI). To compare the safety and preliminary efficacy of orally administered lyophilized microbiota product compared with frozen product by enema. In a single center, adults with ≥ 3 episodes of recurrent CDI were randomized to receive encapsulated lyophilized fecal microbiota from 100-200 g of donor feces (n = 31) or frozen FMT from 100 g of donor feces (n = 34) by enema. Safety during the three months post FMT was the primary study objective. Prevention of CDI recurrence during the 60 days after FMT was a secondary objective. Fecal microbiome changes were examined in first 39 subjects studied. Adverse experiences were commonly seen in equal frequency in both groups and did not appear to relate to the route of delivery of FMT. CDI recurrence was prevented in 26 of 31 (84%) subjects randomized to capsules and in 30 of 34 (88%) receiving FMT by enema (p = 0.76). Both products normalized fecal microbiota diversity while the lyophilized orally administered product was less effective in repleting Bacteroidia and Verrucomicrobia classes compared to frozen product via enema. The route of delivery, oral or rectal, did not influence adverse experiences in FMT. In preliminary evaluation, both routes appeared to show equivalent efficacy, although the dose may need to be higher for lyophilized product. Spore-forming bacteria appear to be the most important engrafting organisms in FMT by the oral route using lyophilized product. ClinicalTrials.gov NCT02449174.