Infectious Disease

Bezlotoxumab reduces the likelihood of recurrent C. difficile infection in transplant recipients

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Johnson does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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Bezlotoxumab significantly reduced the incidence of recurrent Clostridioides difficile infections in solid organ and haematopoietic cell transplant recipients, according to a study published in the Open Forum Infectious Diseases.

“Solid organ and hematopoietic cell transplant recipients are at high risk of recurring Clostridioides difficile infections and poor outcomes associated with these infections.” Tanner M. Johnson, PharmD, AAHIVP, a PGY2 infectious disease pharmacist based at the University of Colorado Hospital and colleagues wrote.

vs. difficult picture

Bezlotoxumab significantly reduced the incidence of recurrent Clostridioides difficile infections in recipients of solid organ and haematopoietic cell transplants. Source: Adobe Stock.

“This study was originally intended to evaluate the use of bezlotoxumab in our facility,” Johnson told Healio. “Based on our use, most of our bezlotoxumab recipients were transplant recipients, so we were curious to investigate what real-world results this patient population had after receiving bezlotoxumab, as this was not previously reported in the literature.”

In addition to the fact that transplant recipients are at increased risk of recurrent C. difficile infection due to their previous infections and immunocompromised status, “C. difficile is associated with significant morbidity in this patient population, including an increased risk of severe CDI and graft failure, ”said Johnson.

Bezlotoxumab, which was approved by the FDA in 2016 for the prevention of recurrent CDI in adults, “is an exciting new agent that has not only been shown to reduce recurrent CDI in the general population, but also to reduce the incidence of recurrent CDI-related illnesses” said Johnson. “We were hoping for similar results in this high-risk group.”

Tanner M. Johnson

Johnson and colleagues performed a retrospective single center analysis comparing recurrent CDI in solid organ and hematopoietic cell transplant recipients who received standard treatment or oral vancomycin, fidaxomicin or metronidazole alone, or bezlotoxumab plus standard treatment. The primary endpoint was the 90-day incidence of recurrent CDI. Secondary endpoints included 90-day hospital admissions, mortality, and the incidence of a heart failure exacerbation.

A total of 94 patients received bezlotoxumab plus standard treatment (n = 38) or standard treatment alone (n = 56), and most patients were solid organ transplant recipients (76%), with the median time to CDI indexation 2.7 years after the Transplant occurred.

According to Johnson and colleagues, 16% of patients in the bezlotoxumab arm of the study experienced 90-day recurrent CDI compared to 29% of patients in the standard care arm. They calculated that bezlotoxumab was associated with a significantly lower likelihood of 90-day relapse CDI (OR = 0.28; 95% CI, 0.08-0.91) and reported that there were no differences in the secondary ones There were endpoints between groups and no recorded heart failure exacerbations.

“I am a strong believer that bezlotoxumab therapy should be considered for all patients with one or more non-modifiable risk factors for recurrent CDI,” said Johnson. “By definition, this includes all transplant recipients who are secondary to receiving immunosuppressive drugs. Our study shows that this drug is beneficial in this population, although larger prospective studies are needed to confirm these results. “

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