Advances in therapy · 2026
Comparative Effectiveness and Safety of Fecal Microbiota Transplantation in Ulcerative Colitis: An Updated Systematic Review and Meta-Analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Huang Bin, An Honglin, Qiu Yiman, Ye Tingting, Huang Yuqing, Zheng Mingxuan, Shi Dan, Su Yanqing, Wang Rong
Аннотация
INTRODUCTION: Fecal microbiota transplantation (FMT) is a potential therapy for ulcerative colitis (UC). Evidence has expanded, but the impact of delivery route on efficacy and safety remains uncertain.
METHODS: We systematically searched PubMed, Embase, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) from inception to October 2025 for randomized controlled trials (RCTs) comparing donor-derived FMT with placebo/sham or autologous FMT in patients with UC. Primary outcomes were clinical and endoscopic remission at induction (8-12 weeks). Adverse events (AEs) were secondary. Random effect models generated risk ratios (RRs) with 95% CIs. Pre-specified subgroup analyses compared delivery routes (colonoscopy, rectal enema, combined colonoscopy + enema, nasoduodenal infusion, oral capsules).
RESULTS: Sixteen RCTs were included. Overall, FMT improved clinical remission (RR = 1.81, 95% CI: 1.41-2.31; I2 = 0%) and endoscopic remission (RR = 1.74, 95% CI: 1.00-3.01; I2 = 45.5%). By route, significant effects were seen for colonoscopy (RR = 1.58, 95% CI 1.05-2.37), rectal enema (RR = 1.62, 95% CI 1.04-2.54) and combined colonoscopy + enema (RR = 2.39, 95% CI 1.47-3.89) for clinical remission; nasoduodenal and oral capsule results were imprecise. For endoscopic remission, the combined route showed the most consistent benefit (RR = 2.19, 95% CI 1.04-4.62). AEs did not differ from control (RR = 1.03, 95% CI 0.90-1.18; I2 = 11.2%).
CONCLUSIONS: FMT improves induction-phase clinical and endoscopic remission in patients with UC without increasing AEs. Efficacy appears route-dependent, with colonoscopy + enema demonstrating the largest effect. Head-to-head trials optimizing route and dosing with longer follow-up are warranted.
METHODS: We systematically searched PubMed, Embase, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) from inception to October 2025 for randomized controlled trials (RCTs) comparing donor-derived FMT with placebo/sham or autologous FMT in patients with UC. Primary outcomes were clinical and endoscopic remission at induction (8-12 weeks). Adverse events (AEs) were secondary. Random effect models generated risk ratios (RRs) with 95% CIs. Pre-specified subgroup analyses compared delivery routes (colonoscopy, rectal enema, combined colonoscopy + enema, nasoduodenal infusion, oral capsules).
RESULTS: Sixteen RCTs were included. Overall, FMT improved clinical remission (RR = 1.81, 95% CI: 1.41-2.31; I2 = 0%) and endoscopic remission (RR = 1.74, 95% CI: 1.00-3.01; I2 = 45.5%). By route, significant effects were seen for colonoscopy (RR = 1.58, 95% CI 1.05-2.37), rectal enema (RR = 1.62, 95% CI 1.04-2.54) and combined colonoscopy + enema (RR = 2.39, 95% CI 1.47-3.89) for clinical remission; nasoduodenal and oral capsule results were imprecise. For endoscopic remission, the combined route showed the most consistent benefit (RR = 2.19, 95% CI 1.04-4.62). AEs did not differ from control (RR = 1.03, 95% CI 0.90-1.18; I2 = 11.2%).
CONCLUSIONS: FMT improves induction-phase clinical and endoscopic remission in patients with UC without increasing AEs. Efficacy appears route-dependent, with colonoscopy + enema demonstrating the largest effect. Head-to-head trials optimizing route and dosing with longer follow-up are warranted.