S2125 Efficacy of Bezlotoxumab in Recurrent Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

Introduction: Clostridioides difficile infection (CDI) management remains one of the most persistent clinical challenges. Despite successful treatment, nearly 30% of patients experience recurrence. Recurrent CDI (rCDI) poses significant risk of serious complications. Furthermore, patients who have a first recurrence face an even higher risk of second recurrence. Our study aims to explore the efficacy of bezlotoxumab (BZX) in reducing the risk of rCDI. Methods: The review conducted follows the PRISMA guidelines and major medical databases, which include PUBMED, Google Scholar and Science-Direct, were extensively searched using a comprehensive search term to identify and retrieve available articles. The articles which included the assessment of recurrence events of CDI following BZX infusion and standard treatment were included in the final analysis. The data was analyzed using the Meta, Metadata and the Metafor packages of R Studio. The proportion of the odds ratio (OR) of recurrence of CDI was assessed as our primary outcome. The OR of initial cure rates following treatment of recurrent CDI was assessed. The Mantel-Haenszel method (common effect model) and the Inverse variance method (random effects model) was utilized to analyze the OR. Results: The review includes a total of 10 articles that assessed the recurrence rates of CDI infection following BZX infusion and standard care. There were 2,926 patients in the BZX administration group and 2,638 patients of the control group. The primary outcome assessed was the OR of recurrence of CDI infection between the 2 groups, the odds of a recurrence of CDI was significantly lower in the BZX infusion group in comparison to the standard treatment protocol (OR = 0.59 [0.54;0.65], 95% confidence interval [CI], P = 0.67 , I2 = 0%). The initial cure rate was assessed in 4 articles, the initial cure rates did not significantly differ between the 2 groups (OR = 1.00 [0.97;1.03], P = 0.91, I2 = 0%). Conclusion: Our study supports the utility of BZX as an effective monoclonal antibody for reducing recurrence rates in rCDI, particularly among high-risk groups. However, use of BZX did not translate into higher initial cure rates.