Bezlotoxumab in the real world: A retrospective study that may elucidate who benefits the most

Reviewed By: S. Shaefer Spires, MD, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC

The authors compared 53 patients who received bezlotoxumab to 53 patients receiving SOC and found an absolute risk reduction of 32% in those receiving bezlotoxumab. Bezlotoxumab was associated with highest difference in recurrence rates in those with 1-2 risk factors (compared to ≥3) and among those with <2 prior episodes of recurrent CDI (compared to those with ≥2), suggesting that there may be more of a benefit in using bezlotoxumab earlier in the natural history of recurrences and perhaps also in the sweet spot of those patients with 1-2 risk factors for recurrence. In the adjusted analysis using inverse probability of treatment weighting, bezlotoxumab remained significantly associated with lower odds of 90-day recurrence and all-cause hospital readmission.  Notably, in the few recurrences that did occur in the bezlotoxumab group, all of them were receiving SOC at the time of administration, suggesting that rushing to give bezlotoxumab while the patient remains in the hospital may not be the best method unless their stay is anticipated to be prolonged by other factors beyond the SOC treatment duration. It should be noted however that fidaxomicin was used more in the bezlotoxumab cohort (32% vs 9%, P=.004) which may skew the results towards a benefit for bezlotoxumab.

Tanner M Johnson et al., “Real-World Comparison of Bezlotoxumab to Standard of Care Therapy for Prevention of Recurrent Clostridioides difficile Infection in Patients at High Risk for Recurrence,” Clinical Infectious Diseases 74, no. 9 (May 1, 2022): 1572–78,

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