Fecal transplant: oral capsules are a welcomed alternative

Does the route of administration of a fecal transplant affect its efficacy? To answer this question and pave the way to a less invasive treatment, a team of Canadian researchers compared the efficacy of oral capsules with that of colonoscopy which is the standard treatment to prevent Clostridium difficile infection relapses.

 

Although it is usually benign, the infection caused by the bacterium called C. difficile may turn out to be very dangerous and even lethal in some cases. It most commonly affects immunocompromised patients, making healthcare facilities an ideal place for the bacteria to spread. This infection causes diarrhea, sometimes very severe, and may recur despite antibiotic treatments to which the bacterium becomes resistant.

Fecal transplant: how is it delivered?

Fortunately, fecal microbiota transplant is approximately 90% effective in treating these relapsing infections.  This old technique, which has just been scientifically validated, is a procedure in which stool from a healthy donor is placed in the digestive tract of a diseased recipient in order to restore the balance of his/her intestinal flora. A team of Canadian researchers from the University of Alberta wanted to go further by comparing the standard colonoscopy treatment to the promising oral capsules. Their intention was to develop a lot less unpleasant solution for patients and significantly improve their living comfort.

Comparable efficacy

105 adult patients with the relapsing form of the infection were included in the clinical trial. The objective was to measure the efficacy of oral stool transplant in the hope of obtaining non-inferior results to those of colonoscopy. Results were excellent for both routes of administration: in 96.2% of cases relapses were prevented in the 12-week period after the transplant administered as a single treatment. In addition, the rate of minor adverse events dropped and the cost was roughly three times lower for the oral administration route. Although the study did not show a clear difference in terms of quality of life, two thirds of patients treated with capsules qualified their experience as “not unpleasant at all” compared to two out of five for those who underwent colonoscopy. All these conclusions allowed the scientists to confirm that fecal transplant via capsules can now be part of the therapeutic arsenal to fight relapsing Clostridium difficile infections and become a new avenue for cost reduction.

 

Sources:

Kao D., Roach B., Silva M. et al. Effect of Oral Capsule– vs Colonoscopy-Delivered Fecal Microbiota Transplantation on Recurrent Clostridium difficile Infection / A Randomized Clinical Trial - JAMA November 28, 2017 Volume 318, Number 20