Outcomes After Fecal Microbiota Transplantation in Combination With Bezlotoxumab for Inflammatory Bowel Disease and Recurrent Clostridioides difficile Infection

Jessica R Allegretti; Jordan Axelrad; Rahul S Dalal; Colleen R Kelly; Ari Grinspan; Monika Fischer

doi:10.14309/ajg.0000000000002770

Outcomes After Fecal Microbiota Transplantation in Combination With Bezlotoxumab for Inflammatory Bowel Disease and Recurrent Clostridioides difficile Infection

Am J Gastroenterol. 2024 Apr 18. doi: 10.14309/ajg.0000000000002770. Online ahead of print.

Authors

Jessica R Allegretti^{1

2}, Jordan Axelrad³, Rahul S Dalal^{1

2}, Colleen R Kelly^{1

2}, Ari Grinspan⁴, Monika Fischer⁵

Affiliations

¹ Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
² Harvard Medical School, Boston, Massachusetts, USA.
³ Division of Gastroenterology, NYU Grossman School of Medicine, New York, New York, USA.
⁴ The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁵ Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA.

PMID: 38501667
DOI: 10.14309/ajg.0000000000002770

Abstract

Fecal microbiota transplantation (FMT) prevents recurrent Clostridioides difficile infections (rCDI) in patients with inflammatory bowel disease. Bezlotoxumab is also indicated to prevent rCDI. We assess the impact of FMT in combination with bezlotoxumab in patients with inflammatory bowel disease and rCDI. We conducted a multicenter randomized placebo-controlled trial. All received a single colonoscopic FMT. Patients were randomized 1:1 to receive bezlotoxumab or placebo. Sixty-one patients were enrolled (30 received treatment and 31 received placebo). Overall, 5 participants (8%) experienced a CDI recurrence; 4 in the treatment arm, 1 in the placebo arm (13% vs 3%, P = 0.15). There was no clear benefit to the combination approach compared with FMT alone.

Grants and funding

Merck