VIDEO: ‘Future is now here’ for recurrent C. difficile, thanks to live biotherapeutics
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VANCOUVER, British Columbia — In this Healio video exclusive, Paul Feuerstadt, MD, FACG, AGAF, discusses the evolution of treatment for Clostridioides difficile infection, from antimicrobials to recently FDA-approved live biotherapeutics.
“It’s so important for us to understand that C. diff has a major impact on our society,” Feuerstadt, assistant clinical professor of medicine at Yale School of Medicine and attending gastroenterologist at PACT Gastroenterology Center, told Healio. “It’s estimated that about 365,000 people will be diagnosed with this infection on an annual basis. The biggest challenge with this, as clinicians certainly know, is recurrence.”
He added, “Anything that we have in our armamentarium to prevent recurrence can be incredibly helpful.”
In his presentation at the ACG Annual Scientific Meeting, Feuerstadt noted that antimicrobials, such as ACG guideline-recommended vancomycin or fidaxomicin, are the “root of all treatments for C. difficile” for initial infection. For recurrence, a vancomycin taper or fidaxomicin for 10 days is indicated.
Symptoms are caused by the vegetative phase of infection, he said, while the spore phase results in the spread of C. difficile, which can be eradicated by a healthy, diverse microbiota. “After we treat with a standard-of-care antimicrobial, like vancomycin or fidaxomicin, it is up to the microbiota to replenish depletions, specifically Bacteroides and Firmicutes.”
However, Feuerstadt noted that “the future is now here,” thanks to the recent FDA-approval of two live biotherapeutic products, which can be given after antimicrobials: Rebyota (fecal microbiota, live-jslm, Ferring Pharmaceuticals) and Vowst (fecal microbiota spores, live-brpk, Nestlé Health Science/Seres Therapeutics), both of which have demonstrated safety and efficacy vs. placebo in clinical trials.
“It’s incredibly exciting that over the last 15 years we’ve been performing rudimentary fecal transplants, but now we have sophisticated live biotherapeutic products that have different administration methods,” Feuerstadt said, noting that either product can be considered after first or second C. difficile recurrence, depending on a patient’s risk.
“Each one of us as clinicians should be fully capable of prescribing this and be comfortable talking to patients about the deficiency in the microbiota, supplementing that deficiency in the microbiota and applying this preventing recurrence in the future,” he said.
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Feuerstadt P. Moderation of the microbiome and C. difficile infection: Have we finally made it? Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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