Journal Article

Safety and efficacy of faecal microbiota transplantation for active peripheral psoriatic arthritis: an exploratory randomised placebo-controlled trial

Christensen, Robin, de Wit, Maarten, Möller, Sören, Just, Søren Andreas, Kjeldsen, Jens, Ellingsen, Torkell, Andersen, Vibeke, Kragsnaes, Maja Skov, Horn, Hans Christian, Ahlquist, Palle, Pedersen, Finn Moeller, Kinggaard Holm, Dorte, Munk, Heidi Lausten, Kristiansen, Karsten, Holt, Hanne Marie, Pedersen, Jens Kristian

2021

Overview

ObjectivesAlthough causality remains to be established, targeting dysbiosis of the intestinal microbiota by faecal microbiota transplantation (FMT) has been proposed as a novel treatment for inflammatory diseases. In this exploratory, proof-of-concept study, we evaluated the safety and efficacy of FMT in psoriatic arthritis (PsA).MethodsIn this double-blind, parallel-group, placebo-controlled, superiority trial, we randomly allocated (1:1) adults with active peripheral PsA (≥3 swollen joints) despite ongoing treatment with methotrexate to one gastroscopic-guided FMT or sham transplantation into the duodenum. Safety was monitored throughout the trial. The primary efficacy endpoint was the proportion of participants experiencing treatment failure (ie, needing treatment intensification) through 26 weeks. Key secondary endpoints were change in Health Assessment Questionnaire Disability Index (HAQ-DI) and American College of Rheumatology (ACR20) response at week 26.ResultsOf 97 screened, 31 (32%) underwent randomisation (15 allocated to FMT) and 30 (97%) completed the 26-week clinical evaluation. No serious adverse events were observed. Treatment failure occurred more frequently in the FMT group than in the sham group (9 (60%) vs 3 (19%); risk ratio, 3.20; 95% CI 1.06 to 9.62; p=0.018). Improvement in HAQ-DI differed between groups (0.07 vs 0.30) by 0.23 points (95% CI 0.02 to 0.44; p=0.031) in favour of sham. There was no difference in the proportion of ACR20 responders between groups (7 of 15 (47%) vs 8 of 16 (50%)).ConclusionsIn this first preliminary, interventional randomised controlled trial of FMT in immune-mediated arthritis, we did not observe any serious adverse events. Overall, FMT appeared to be inferior to sham in treating active peripheral PsA.Trial registration number NCT03058900.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited
• Subject: Adult / Adverse events / Antirheumatic Agents - therapeutic use / Arthritis / Arthritis, Psoriatic - microbiology / Arthritis, Psoriatic - therapy / Clinical medicine / Clinical trials / COVID-19 / Drug dosages / Duodenum / Dysbacteriosis / Dysbiosis - therapy / Fecal Microbiota Transplantation - methods / Female / Humans / inflammation / Inflammatory bowel disease / Inflammatory diseases / Intestinal microflora / Joint diseases / Male / Methotrexate / Methotrexate - therapeutic use / Microbiota / Middle Aged / Patients / Placebos / Proof of Concept Study / psoriatic / Psoriatic arthritis / Rheumatology / Safety / therapeutics / Transplantation / Transplants & implants / Treatment Outcome