יעילות הטיפול בהשתלת צואה במבוגרים הלוקים באטופיק דרמטיטיס בינונית עד קשה

Background: A growing body of data suggests that gut dysbiosis may contribute to the pathogenesis of atopic dermatitis (AD) through immune dysregulation.

Objective: We aimed at assessing the efficacy and safety of fecal microbiota transplantation (FMT) for AD.

Methods: A prospective, single-blinded, placebo-controlled cross-over pilot study among moderate-to-severe AD patients was performed. All patients received 2 placebo fecal transplantations followed by 4 FMTs from healthy donors 2 weeks apart.

Results: Ten patients completed the study protocol, one of whom was excluded due to study regulations breach. There was no significant change in the severity of AD following the two placebo transplants. Two weeks following all four doses of FMT there was a significant reduction in the SCORAD score (59.2%±34.9%). Reduction in maximal SCORAD score and weekly corticoids use during the intervention and follow-up period was even higher (84%±7%, and 90.5%±10.7%, respectively). Seven patients had long lasting almost complete response to therapy (average SCORAD reduction at week 12 of 71.5%±20.2%, and maximal reduction during the FMTs and the follow-up period of 85.6%%±7.8%) and two had a temporary yet significant response (average maximal SCORAD reduction of 78.5%), followed by gradual loss of response during the following FMTs, necessitating switching to another treatment mode. Of the seven responders who continued follow-up, two patients developed exacerbation 32 and 21 weeks after the 4th FMT respectively. Each received an additional fifth FMT which resulted in a 80% and 40% SCORAD score reduction, respectively. Metagenomic analysis of the fecal microbiota showed transmission of bacterial strains from donors to patients. No adverse events were recorded during the study and follow-up period.

Conclusions: Treatment of moderate-to-severe AD with FMT seems to be safe and effective. These results remain to be confirmed in the context of larger placebo-controlled double blind studies.