Bezlotoxumab for the prevention of Clostridium difficile recurrence

ABSTRACT

Introduction: Clostridium difficile infection is a major economic and clinical burden, due to its high frequency of recurrence. Currently recommended treatments are not efficient for prevention and may contribute to the risk of recurrent infection. In recent years, research has focused on strategies to lessen this risk. Bezlotoxumab is a monoclonal antibody that prevents recurrences of C. difficile infection through the antagonism of toxin B.

Areas covered: In this review, the authors discuss the burden of C. difficile infection and its recurrences, the mechanisms underlying the recurrences, and current C. difficile treatments. They subsequently analyze the strategic therapeutic rationale for bezlotoxumab use, as well as the supporting clinical evidence.

Expert opinion: Bezlotoxumab is an attractive solution for reducing the unacceptable level of recurrence that occurs with the currently recommended C. difficile treatments and other alternative therapies under consideration. Even though bezlotoxumab has not been tested in large-scale trials exclusively in cases of already established recurrent C.difficile infection (rCDI), it has an advantage over current treatments in that it does not interfere with the patient’s gut flora while directly neutralizing the key virulence factor. Although cost remains an important factor against its widespread use, simpler administration, fewer side-effects, and better social acceptability justify its consideration for treating rCDI.

KEYWORDS:

• Monoclonal antibody
• Clostridium difficile
• recurrence
• bezlotoxumab

Acknowledgments

The authors wish to thank Editage for editing the English language.

Declaration of interest

L Valiquette was a consultant to Pfizer Inc and Optimer Pharmaceuticals. He also received research grants from Pfizer Inc, Optimer Pharmaceuticals, Merck & Co as well as Sanofi Pasteur and has received honorarium for lectures from Optimer Pharmaceuticals. A Carignan also reports having received fees for lectures from and has served on the advisory boards of Pfizer Inc and Merck & Co. He also received clinical trial fees from Sanofi Pasteur. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This manuscript has not been funded.