Add-on interventions for the prevention of recurrent Clostridioides Difficile infection: A systematic review and network meta-analysis.
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ administration & dosage
Antibodies, Monoclonal
/ therapeutic use
Broadly Neutralizing Antibodies
/ therapeutic use
Clostridioides difficile
/ drug effects
Clostridium Infections
/ microbiology
Female
Humans
Male
Middle Aged
Network Meta-Analysis
Probiotics
/ administration & dosage
Randomized Controlled Trials as Topic
Clostridioides difficile
Network meta-analysis
Prevention
Recurrent
Systematic review
Journal
Anaerobe
ISSN: 1095-8274
Titre abrégé: Anaerobe
Pays: England
ID NLM: 9505216
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
29
03
2021
revised:
10
08
2021
accepted:
24
08
2021
pubmed:
29
8
2021
medline:
11
2
2022
entrez:
28
8
2021
Statut:
ppublish
Résumé
We aimed to assess the comparative efficacy and safety of adjunctive interventions for the prevention of Clostridioides difficile recurrence. We searched Medline, Embase, CENTRAL, and clinicaltrials.gov up to May 2021. We included randomized controlled trials comparing interventions added to antibiotic therapy for prevention of CDI recurrence, to placebo or each other. Efficacy outcomes were CDI and diarrhea recurrence. Safety outcomes included the incidence of any adverse event (AE), serious AEs, and discontinuation due to AEs. We performed random-effects network meta-analysis. We ranked interventions based on SUCRA (surface under the cumulative ranking curve) probabilities. We assessed confidence in estimates utilizing the CINeMA (Confidence in Network Meta-Analysis) framework. Fifteen trials (3909 patients) assessed 9 interventions. Oligofructose (OR 0.17; 95% CI, 0.07 to 0.46), NTCD-M3 (OR 0.29; 95% CI, 0.12 to 0.68), rifaximin (OR 0.47; 95% CI, 0.24 to 0.93), RBX2660 (OR 0.47; 95% CI, 0.22 to 0.99), the combination bezlotoxumab/actoxumab (OR 0.47; 95% CI, 0.37 to 0.60), and bezlotoxumab (OR, 0.53; 95% CI, 0.42 to 0.68) were associated with lower incidence of CDI recurrence than placebo (moderate confidence). Oligofructose was ranked highest, however data for oligofructose were derived solely from one small trial. Probiotics, actoxumab and SER-109 were not superior to placebo (low confidence). Probiotics were not well tolerated (low confidence) and actoxumab showed high rates of serious AEs (moderate confidence). Add-on treatment with oligofructose, NTCD-M3 spores, rifaximin, RBX2660, and bezlotoxumab likely reduces the risk of CDI. Evidence on probiotics and SER-109 are uncertain, thus adequately powered trials are warranted.
Identifiants
pubmed: 34454094
pii: S1075-9964(21)00124-4
doi: 10.1016/j.anaerobe.2021.102441
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Antibodies, Monoclonal
0
Broadly Neutralizing Antibodies
0
bezlotoxumab
4H5YMK1H2E
actoxumab
G3LU5LC5SX
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
102441Informations de copyright
Copyright © 2021 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest None declared.