Bezlotoxumab for Preventing Recurrent Clostridioides difficile Infection: A Narrative Review from Pathophysiology to Clinical Studies

doi:10.1007/s40121-020-00314-5

Review

. 2020 Sep;9(3):481-494.

doi: 10.1007/s40121-020-00314-5. Epub 2020 Jul 6.

Bezlotoxumab for Preventing Recurrent Clostridioides difficile Infection: A Narrative Review from Pathophysiology to Clinical Studies

Daniele Roberto Giacobbe^{1

2}, Silvia Dettori^{3

4}, Stefano Di Bella⁵, Antonio Vena³, Guido Granata⁶, Roberto Luzzati⁵, Nicola Petrosillo⁶, Matteo Bassetti^{3

4}

Affiliations

¹ Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy. daniele.roberto.giacobbe@gmail.com.
² Department of Health Sciences, University of Genoa, Genoa, Italy. daniele.roberto.giacobbe@gmail.com.
³ Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
⁴ Department of Health Sciences, University of Genoa, Genoa, Italy.
⁵ Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy.
⁶ Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy.

PMID: 32632582
PMCID: PMC7452994
DOI: 10.1007/s40121-020-00314-5

Review

Bezlotoxumab for Preventing Recurrent Clostridioides difficile Infection: A Narrative Review from Pathophysiology to Clinical Studies

Daniele Roberto Giacobbe et al. Infect Dis Ther. 2020 Sep.

. 2020 Sep;9(3):481-494.

doi: 10.1007/s40121-020-00314-5. Epub 2020 Jul 6.

Authors

Daniele Roberto Giacobbe^{1

2}, Silvia Dettori^{3

4}, Stefano Di Bella⁵, Antonio Vena³, Guido Granata⁶, Roberto Luzzati⁵, Nicola Petrosillo⁶, Matteo Bassetti^{3

4}

Affiliations

¹ Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy. daniele.roberto.giacobbe@gmail.com.
² Department of Health Sciences, University of Genoa, Genoa, Italy. daniele.roberto.giacobbe@gmail.com.
³ Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
⁴ Department of Health Sciences, University of Genoa, Genoa, Italy.
⁵ Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy.
⁶ Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy.

PMID: 32632582
PMCID: PMC7452994
DOI: 10.1007/s40121-020-00314-5

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 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; Recurrence; rCDI.

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Figures

**Fig. 1**
Pathophysiology of CDI and mechanism of action of bezlotoxumab

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References

1. Asha NJ, Tompkins D, Wilcox MH. Comparative analysis of prevalence, risk factors, and molecular epidemiology of antibiotic-associated diarrhea due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus. J Clin Microbiol. 2006;44:2785–2791. - PMC - PubMed
1. Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–241. - PubMed
1. Kociolek LK, Gerding DN. Clinical utility of laboratory detection of Clostridium difficile strain BI/NAP1/027. J Clin Microbiol. 2016;54:19–24. - PMC - PubMed
1. Loo VG, Bourgault AM, Poirier L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365:1693–1703. - PubMed
1. Sheitoyan-Pesant C, Abou Chakra CN, Pepin J, et al. Clinical and healthcare burden of multiple recurrences of Clostridium difficile infection. Clin Infect Dis. 2016;62:574–580. - PubMed

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[1] Asha NJ, Tompkins D, Wilcox MH. Comparative analysis of prevalence, risk factors, and molecular epidemiology of antibiotic-associated diarrhea due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus. J Clin Microbiol. 2006;44:2785–2791. - PMC - PubMed

[2] Asha NJ, Tompkins D, Wilcox MH. Comparative analysis of prevalence, risk factors, and molecular epidemiology of antibiotic-associated diarrhea due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus. J Clin Microbiol. 2006;44:2785–2791. - PMC - PubMed

[3] Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–241. - PubMed

[4] Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–241. - PubMed

[5] Kociolek LK, Gerding DN. Clinical utility of laboratory detection of Clostridium difficile strain BI/NAP1/027. J Clin Microbiol. 2016;54:19–24. - PMC - PubMed

[6] Kociolek LK, Gerding DN. Clinical utility of laboratory detection of Clostridium difficile strain BI/NAP1/027. J Clin Microbiol. 2016;54:19–24. - PMC - PubMed

[7] Loo VG, Bourgault AM, Poirier L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365:1693–1703. - PubMed

[8] Loo VG, Bourgault AM, Poirier L, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365:1693–1703. - PubMed

[9] Sheitoyan-Pesant C, Abou Chakra CN, Pepin J, et al. Clinical and healthcare burden of multiple recurrences of Clostridium difficile infection. Clin Infect Dis. 2016;62:574–580. - PubMed

[10] Sheitoyan-Pesant C, Abou Chakra CN, Pepin J, et al. Clinical and healthcare burden of multiple recurrences of Clostridium difficile infection. Clin Infect Dis. 2016;62:574–580. - PubMed

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Bezlotoxumab for Preventing Recurrent Clostridioides difficile Infection: A Narrative Review from Pathophysiology to Clinical Studies

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Bezlotoxumab for Preventing Recurrent Clostridioides difficile Infection: A Narrative Review from Pathophysiology to Clinical Studies

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