Bezlotoxumab safely prevents recurrent Clostridioides difficile infection

Bezlotoxumab is both safe and effective for the prevention of recurrent Clostridioides difficile infection (rCDI), results of a meta-analysis have shown. Moreover, bezlotoxumab may be a good therapeutic option for severe rather than mild CDI.

“CDI is one of the most common healthcare-associated infections,” the investigators said. “To reduce the rCDI, monoclonal antibodies against C. difficile toxin A (actoxumab) and toxin B (bezlotoxumab) were developed.”

A systematic review and meta-analysis was performed to assess their efficacy and safety. The investigators searched an electronic database for relevant randomized controlled trials (RCTs) assessing bezlotoxumab and/or actoxumab. Outcomes measured were the rate of rCDI and adverse events including cardiovascular and gastrointestinal events.

Four RCTs comparing antitoxin antibodies (n=1,916) with placebo (n=889) were included in the meta-analysis. Bezlotoxumab plus actoxumab significantly reduced rCDI (risk ratio [RR], 0.54, 95 percent confidence interval [CI], 0.41–0.70; p<0.001), as did bezlotoxumab monotherapy (RR, 0.62, 95 percent CI, 0.51–0.76; p<0.001), compared with placebo.

In subgroup analysis, bezlotoxumab plus actoxumab significantly prevented rCDI in patients with high-risk features, such as inpatients, those who received vancomycin treatment, and those with the BI/NAP/027 strain.

In terms of safety, no difference was noted in cardiovascular and gastrointestinal events, as well as all-cause mortality, between patients treated with bezlotoxumab and placebo.