Bezlotoxumab for Preventing Recurrent Clostridioides difficile Infection: A Narrative Review from Pathophysiology to Cli
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REVIEW
Bezlotoxumab for Preventing Recurrent Clostridioides difficile Infection: A Narrative Review from Pathophysiology to Clinical Studies Daniele Roberto Giacobbe
. Silvia Dettori . Stefano Di Bella .
Antonio Vena . Guido Granata . Roberto Luzzati . Nicola Petrosillo . Matteo Bassetti
Received: May 25, 2020 Ó The Author(s) 2020
ABSTRACT Clostridioides difficile infection (CDI) and recurrent CDI (rCDI) remain associated with a reduction in the patients’ quality of life and with increased healthcare costs. Bezlotoxumab is a monoclonal antibody against toxin B of C. difficile, approved for prevention of rCDI. In this narrative review, we briefly discuss the
Enhanced Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare. 12515412. D. R. Giacobbe (&) S. Dettori A. Vena M. Bassetti Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy e-mail: [email protected] D. R. Giacobbe S. Dettori M. Bassetti Department of Health Sciences, University of Genoa, Genoa, Italy S. Di Bella R. Luzzati Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy G. Granata N. Petrosillo Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
pathophysiology of CDI and the mechanism of action of bezlotoxumab, as well as the available evidence from investigational and observational studies in terms of efficacy, effectiveness, and safety of bezlotoxumab for the prevention of rCDI. Overall, bezlotoxumab has proved efficacious in reducing the burden of rCDI, thereby providing clinicians with an important novel strategy to achieve sustained cure. Nonetheless, experiences outside randomized controlled trials (RCTs) remain scant, and mostly represented by case series without a control group. Along with the conduction of RCTs to directly compare bezlotoxumab with faecal microbiota transplantation (or to precisely evaluate the role of their combined use), further widening our post-marketing experience remains paramount to firmly guide the use of bezlotoxumab outside RCTs, and to clearly identify those real-life settings where its preventive benefits can be exploited most.
Keywords: Bezlotoxumab; CDI; Clostridioides; Clostridium; Healthcare-associated infections; Nosocomial infections; rCDI; Recurrence
Infect Dis Ther
Key Summary Points Clostridioides difficile infection (CDI) is a frequent cause of antibiotic-associated diarrhea, which mainly affects elderly patients exposed to broad-spectrum antimicrobials. About 25% of patients with CDI are at risk of developing a recurrent CDI (rCDI) after resolution of the first episode. After the first rCDI, the risk of multiple recurrences increases to 40%. Bezlotoxumab has proved efficacious in reducing the burden of rCDI, thereby providing clinicians with an important novel strategy to achieve sustained cure in patients wit
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