#2-78E. Predictors of FMT Success in PsA: The Role of Gut Microbiota Community Types (A&R, 2025)

In the management of Psoriatic Arthritis (PsA), understanding which patients will achieve a sustained, long-term beneficial response to emerging microbiota-targeted therapies like Fecal Microbiota Transplantation (FMT) is crucial for clinical practice. This exploratory study investigated the association between baseline gut bacterial signatures and long-term clinical outcome following a single-donor FMT in PsA patients receiving methotrexate. Researchers characterized the PsA patient cohort using shotgun metagenomics and identified two primary gut microbiota community types (GMCs): Bacteroides-dominated (B-type) and Prevotella-driven (P-type). The most important finding reveals that patients with a baseline B-type GMC were significantly more likely to achieve a long-term beneficial clinical response at 26 weeks compared to P-type patients (71.4% vs 0% in the per-protocol population). This suggests that GMC typing can potentially serve as a predictive biomarker for FMT efficacy in PsA. However, clinicians must critically note that this was an exploratory study based on a very small per-protocol population of only 13 patients. Despite this limitation, the research provides novel insights for patient stratification, suggesting that evaluating the recipient's gut microbiota community type may guide therapeutic decisions toward more individualized treatment strategies.

Citation: Qin P, Kragsnaes MS, Holm DK, Horn HC, Nilsson AC, Kjeldsen J, Kristiansen K, Ellingsen T. Clinical Significance of Gut Microbiota Community Types for Long-Term Response to Fecal Microbiota Transplantation in Patients With Psoriatic Arthritis. Arthritis & Rheumatology. 2025. DOI: 10.1002/art.43359

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