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Multicenter Study
. 2024 Mar;43(3):533-540.
doi: 10.1007/s10096-024-04762-6. Epub 2024 Jan 18.

Bezlotoxumab during the first episode of Clostridioides difficile infection in patients at high risk of recurrence

Rosa Escudero-Sanchez  1   2   3 , Antonio Ramos-Martínez  4 , Antonio F Caballero-Bermejo  5 , Beatriz Díaz-Pollán  6   7   8 , Guillermo Ruiz-Carrascoso  8   9 , María Olmedo Samperio  10 , Patricia Muñoz García  10 , Paloma Merino Amador  11 , Fernando González Romo  11 , Oriol Martín Segarra  12 , Gema Navarro Jiménez  12 , Laura Del Campo Albendea  13   14 , Alfonso Muriel García  13   14   15 , Javier Cobo  16   17   6
Affiliations
Multicenter Study

Bezlotoxumab during the first episode of Clostridioides difficile infection in patients at high risk of recurrence

Rosa Escudero-Sanchez et al. Eur J Clin Microbiol Infect Dis. 2024 Mar.

Abstract

Purpose: To describe a cohort with a high risk of recurrence who received bezlotoxumab during the first episode of Clostridioides difficile infection (CDI) and to compare this cohort with patients with similar characteristics who did not receive the monoclonal antibody.

Methods: A prospective and multicentre study of patients with a high risk of recurrence (expected recurrence rate>35%) who were treated with bezlotoxumab during their first episode of CDI was conducted. A propensity score-matched model 1:2 was used to compare both cohorts that were weighed according to basal characteristics (hospital-acquisition, creatinine value, and fidaxomicin as a CDI treatment).

Results: Sixty patients (mean age:72 years) were prospectively treated with bezlotoxumab plus anti-Clostridioides antibiotic therapy. Vancomycin (48 patients) and fidaxomicin (12 patients) were prescribed for CDI treatment, and bezlotoxumab was administered at a mean of 4.2 (SD:2.1) days from the beginning of therapy. Recurrence occurred in nine out of 54 (16.7%) evaluable patients at 8 weeks. Forty bezlotoxumab-treated patients were matched with 69 non-bezlotoxumab-treated patients. Recurrence rates at 12 weeks were 15.0% (6/40) in bezlotoxumab-treated patients vs. 23.2% (16/69) in non-bezlotoxumab-treated patients (OR:0.58 [0.20-1.65]). No adverse effects were observed related to bezlotoxumab infusion. Only one of 9 patients with previous heart failure developed heart failure.

Conclusion: We observed that patients treated with bezlotoxumab in a real-world setting during a first episode of CDI having high risk of recurrence, presented low rate of recurrence. However, a significant difference in recurrence could not be proved in comparison to the controls. We did not detect any other safety concerns.

Keywords: Clostridioides difficile; Clostridioides difficile infection; Bezlotoxumab; Recurrence.

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