Fidaxomicin for Clostridioides difficile infection in patients with inflammatory bowel disease: a multicenter retrospective cohort study.
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Noviello Daniele, Chaparro María, Viganò Chiara, Blesl Andreas, Barberio Brigida, Yanai Henit, Orlando Ambrogio, Ferreiro-Iglesias Rocío, Bezzio Cristina, Zilli Alessandra, Molnár Tamás, Gheorghe Cristian, Conforti Francesco, Innocenti Tommaso, Saibeni Simone, Bossuyt Peter, Oliveira Raquel, Carvalhas Gabrielli Anna Maria, Losco Alessandra, Vieujean Sophie, Tettoni Enrico, Pirola Lorena, Calderone Silvia, Kornowski Cohen Maya, Dragoni Gabriele, Rath Timo, Barreiro-de Acosta Manuel, Savarino Edoardo Vincenzo, Gisbert Javier Pérez, Vecchi Maurizio, Atreya Raja, Caprioli Flavio
Аннотация
METHODS: Adult patients with ulcerative colitis (UC) or Crohn's disease (CD) treated with fidaxomicin for documented CDI were retrospectively included. The primary outcome was CDI recurrence rate within 8 weeks (C. difficile toxin detection and CDI-targeted therapy). Secondary outcomes included sustained response (no CDI-targeted therapy within 12 weeks), IBD therapy escalation, colectomy rate, and all-cause mortality within 30, 90, and 180 days.
RESULTS: Ninety-six patients (57 UC and 39 CD) from 20 IBD centers were included. Most were on advanced IBD therapy. Half had a previous CDI episode, 15% a severe episode. CDI recurrence rate was 10% at week 8, and sustained response 82% at week 12. Compared with patients with previous CDI episode, patients at first episode tended to have a lower recurrence (4.3% vs 16%; P = .06) and higher sustained response (91% vs 75%; P = .04) rate. IBD therapy escalation was required in 48% with a numerically lower need for patients achieving vs not-achieving sustained response within 30 days (12% vs 20%; P = .42). Five UC patients underwent colectomy. One death unrelated to CDI or IBD occurred. One moderate and 5 mild adverse events were reported.
CONCLUSIONS: Fidaxomicin was effective and safe in IBD patients with CDI, with greater effectiveness in CDI-naïve patients, potentially influencing short-term IBD outcomes.