Bezlotoxumab, fecal microbiota transplant similarly effective in preventing recurrent CDI
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Bezlotoxumab and fecal microbiota transplantation were similarly effective at preventing both early and late recurrent Clostridioides difficile infection, according to a study published in Open Forum Infectious Diseases.
“This study was prompted by the idea of knowing the current status (indications, therapeutic success) of the treatment (bezlotoxumab and/or fecal microbiota transplantation) that we administer to our patients,” Sofia de la Villa, MD, infectious disease specialist at the Hospital General Universitario Gregorio Marañón, told Healio.
“At present, we do not know if these therapies are equivalent in terms of effectiveness, or if they are not,” de la Villa said.
The researchers performed a retrospective study at a university hospital of adult patients treated with bezlotoxumab or fecal microbiota transplantation between January 2018 and April 2021 to evaluate the effectiveness of bezlotoxumab and fecal microbiota transplantation at preventing early C. difficile infection (CDI) recurrences reported within 8 weeks and late CDI recurrences reported within a year.
Of 1,377 consecutive CDI episodes included in the study, 117 (8.5%) were treated with bezlotoxumab or fecal microbiota transplantation. Full information was available for 100 of these cases and showed that 51 patients received bezlotoxumab, whereas 49 received fecal microbiota transplantation.
Additional data showed that bezlotoxumab was used more often among immunosuppressed patients (66.7%) and in first episodes or first recurrences in 70.6% of the cases, whereas fecal microbiota transplantation was prescribed only in CDI recurrences.
Regardless of different patient conditions, the study showed that there were no significant differences between bezlotoxumab and fecal microbiota transplantation in preventing early recurrent CDI, or rCDI, (19.6% vs. 24.5%; P = .55) or late rCDI (9.8% vs. 18.4%; P = .31).
Additionally, a multivariate analysis showed that risk factors for recurrence included the presence of two or more previous rCDI episodes (OR = 2.90; 95% CI, 1.03-8.63) and the use of non-CDI antibiotics following bezlotoxumab or fecal microbiota transplantation (OR = 3.45; 95% CI, 1.24-9.57).
“We need high-quality clinical trials to be able to evaluate the real efficacy of these therapies and to be positioned in a more concrete way in the guidelines, thus facilitating decision-making for physicians involved in the management of this disease,” de la Villa said.
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