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. 2025 Dec;17(1):2480195.
doi: 10.1080/19490976.2025.2480195. Epub 2025 Mar 21.

Anti-interleukin-23 treatment linked to improved Clostridioides difficile infection survival

Gregory R Madden  1   2 , Robert Preissner  3 , Saskia Preissner  3 , William A Petri  1
Affiliations

Anti-interleukin-23 treatment linked to improved Clostridioides difficile infection survival

Gregory R Madden et al. Gut Microbes. 2025 Dec.

Abstract

Clostridioides difficile is a leading cause of healthcare-associated infection, and an unacceptably high proportion of patients with C. difficile infection die despite conventional antibiotic treatment. Host-directed immunotherapy has been proposed as an ideal treatment modality for C. difficile infection to mitigate the underlying toxin-mediated pathogenic immune response while sparing protective gut microbes. Interleukin-23 monoclonal antibody inhibitors are used extensively to control pro-inflammatory Th17 immune pathways in psoriasis and inflammatory bowel disease that are similarly important during C. difficile infection. We used a large retrospective electronic health record database to test the hypothesis that hospitalized patients with C. difficile infection who are on anti-IL-23 treatment will have improved survival compared to patients without anti-IL-23. A total of 9,301 anti-IL-23 patients had significantly lower probability of all-cause death within 30 d (0.54%) compared with 1:1 propensity-matched control patients (3.1%). IL-23 inhibition is a promising adjunct to C. difficile treatment, and further clinical trials repositioning anti-IL-23 monoclonal antibodies from psoriasis and inflammatory bowel disease to C. difficile infection are warranted.

Keywords: C. difficile infection; Clostridioides difficile; IL-23; Th17 immunity; interleukin-23; monoclonal antibody; retrospective study.

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Conflict of interest statement

W. A. Petri is a consultant for TechLab Inc., a company that manufactures diagnostic tests for C. difficile toxins. All other authors report no conflicts of interest relevant to this article.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curve.
See this image and copyright information in PMC

Update of

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