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Lyophilized versus Frozen Fecal Microbiota Transplant for Recurrent Clostridium Difficile Infection, Inflammatory Bowel Disease, and Irritable Bowel Syndrome: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: August 14, 2019
Project Number: RC1166-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of lyophilized fecal microbiota transplantation versus frozen fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection, inflammatory bowel disease, or irritable bowel syndrome?
  2. What is the comparative cost-effectiveness of lyophilized fecal microbiota transplantation versus frozen fecal microbiota transplantation for the treatment of patients with recurrent Clostridium difficile infection, inflammatory bowel disease, or irritable bowel syndrome?
  3. What are the evidence-based guidelines regarding lyophilized fecal microbiota transplantation for the treatment of patients with recurrent Clostridium difficile infection, inflammatory bowel disease, or irritable bowel syndrome?

Key Message

Two randomized controlled trials were identified regarding the clinical effectiveness of lyophilized versus frozen fecal microbiota transplant for recurrent Clostridium difficile infection. Evidence of limited quality from the two studies identified no statistically significant difference in cure rates for CDI between lyophilized and frozen fecal microbiota transplant via colonoscopy, and no difference in adverse events between oral lyophilized fecal microbiota transplant and frozen fecal microbiota transplant enema. The evidence presented in this report should be interpreted with caution based on the limitations and paucity of comparative data. No relevant literature was found regarding clinical effectiveness of lyophilized versus frozen FMT for the IBD and IBS indications, or the cost-effectiveness of lyophilized versus frozen FMT for CDI, IBD and IBS. No relevant evidence-based guidelines were identified.