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Efficacy and safety of fecal transplantation versus targeted therapies in ulcerative colitis: network meta-analysis

    Sudheer K Vuyyuru

    Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India

    ,
    Saurabh Kedia

    Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India

    ,
    Mani Kalaivani

    Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India

    ,
    Pabitra Sahu

    Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India

    ,
    Bhaskar Kante

    Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India

    ,
    Peeyush Kumar

    Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India

    ,
    Mukesh K Ranjan

    Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India

    ,
    Govind Makharia

    Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India

    ,
    Ashwin Ananthakrishnan

    Division of Gastroenterology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA

    &
    Vineet Ahuja

    *Author for correspondence: Tel.: +91 112 659 3300;

    E-mail Address: vineet.aiims@gmail.com

    Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India

    Published Online:https://doi.org/10.2217/fmb-2020-0242

    Aim: We conducted this network meta-analysis to compare the efficacy and safety of targeted pharmacotherapies and fecal microbial transplantation (FMT). Patients & methods: Nineteen studies were included and there was only one head-to-head randomized controlled trial (adalimumab vs vedolizumab). Results: All interventions, including FMT, were superior to a placebo in inducing clinical remission (except adalimumab – odds ratio 1.66; 95% CI: 0.97–2.85), clinical response and endoscopic remission. FMT was comparable with other agents in achieving all efficacy outcomes. Infliximab was ranked highest in inducing clinical remission (surface under the cumulative ranking, 0.8). There was no difference in safety outcomes between FMT and other targeted therapies. Conclusion: FMT is as efficacious and as safe as other targeted therapies in inducing clinical remission, clinical response and endoscopic remission. Further studies to assess the long-term benefits are needed in order to reach a definitive conclusion.

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