Bezlotoxumab reduces odds of recurrent C. difficile infection in transplant recipients
Bezlotoxumab significantly reduced the incidence of recurrent Clostridioides difficile infection among solid-organ transplant and hematopoietic-cell transplant recipients, according to a study published in Open Forum Infectious Diseases.
“Solid-organ and hematopoietic-cell transplant recipients are at high-risk for recurrent Clostridioides difficile infection and poor outcomes associated with these infections,” Tanner M. Johnson, PharmD, AAHIVP, a PGY2 infectious disease pharmacy resident at the University of Colorado Hospital, and colleagues wrote.
“This study initially sought to evaluate bezlotoxumab utilization at our institution,” Johnson told Healio. “Based on our usage, a majority of our bezlotoxumab recipients were transplant recipients, so we were curious to study what sort of real-world outcomes this patient population had after bezlotoxumab receipt because this was not previously reported in the literature.”
In addition to transplant recipients being at an increased risk for recurrent C. difficile infection due to their previous infections and immunocompromised status, “C. difficile in this patient population is associated with significant morbidity, including increased risks of severe CDI and graft failure,” Johnson said.
Bezlotoxumab, which was approved by the FDA in 2016 for the prevention of recurrent CDI in adults, “is an interesting 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 hospital readmission,” Johnson said “In this high-risk population, we hoped to see similar results.”
Johnson and colleagues conducted a single-center retrospective analysis comparing recurrent CDI in solid-organ and hematopoietic cell transplant recipients receiving standard of care alone oral vancomycin, fidaxomicin or metronidazole or bezlotoxumab plus standard of care. The primary outcome was 90-day incidence of recurrent CDI. Secondary outcomes included 90-day hospital readmission, mortality and incidence of heart failure exacerbation.
Overall, 94 patients received bezlotoxumab plus standard of care (n = 38) or standard of care alone (n = 56) and most patients were solid-organ transplant recipients (76%), with median time to index CDI occurring 2.7 years after transplantation.
According to Johnson and colleagues, 90-day recurrent CDI occurred in 16% of patients in the bezlotoxumab arm of the study compared with 29% of patients in the standard-of-care arm. They calculated that bezlotoxumab was associated with significantly lower odds of 90-day recurrent CDI (OR = 0.28; 95% CI, 0.08-0.91), and reported that there were no differences in secondary outcomes between groups and no recorded heart failure exacerbations.
“I am a strong proponent that bezlotoxumab therapy should be considered for all patients with one or more nonmodifiable risk factors for recurrent CDI,” Johnson said. “By definition, this includes all transplant recipients secondary to receipt of immunosuppressive medications. Our study shows that this medication is advantageous in this population, although larger prospective trials are needed to confirm these findings.”