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SYSTEMATIC REVIEW article

Front. Pharmacol.
Sec. Gastrointestinal and Hepatic Pharmacology
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1430724
This article is part of the Research Topic Gut Microbiota and Gastrointestinal Disorders - Volume II View all 8 articles

Comparative effectiveness of treatments for recurrent Clostridioides difficile infection: a network meta-analysis of randomized controlled trials

Provisionally accepted
Hong Duo Hong Duo 1,2Yanwei Yang Yanwei Yang 3Guqin Zhang Guqin Zhang 1Yingxin Chen Yingxin Chen 4Yumeng Cao Yumeng Cao 1Linjie Luo Linjie Luo 5Qifa Ye Qifa Ye 1*Huaqin Pan Huaqin Pan 3*
  • 1 Zhongnan Hospital, Wuhan University, Wuhan, Hubei Province, China
  • 2 Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Wuhan, China
  • 3 Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
  • 4 Xi’an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
  • 5 University of Texas MD Anderson Cancer Center, Houston, Texas, United States

The final, formatted version of the article will be published soon.

    Background: Clostridioides difficile infection (CDI) is the most common cause of healthcare-associated infectious diarrhea. A major clinical challenge is recurrent CDI (rCDI) without effective standard drug-based therapy. Additionally, a comprehensive comparison of various therapy effectiveness in rCDI patients is still under investigation. Methods: A Bayesian network meta-analysis (NMA) of randomized control trials up to March 2024 was performed to investigate the efficacy of rCDI interventions. Results: Seventeen trials were included, comprising 4,148 CDI patients with ten interventions, including fecal microbiota transplantation (FMT) by lower gastrointestinal (LGI), FMT by upper gastrointestinal (UGI), Autologous FMT (AFMT), vancomycin + FMT, vancomycin, placebo, fidaxomicin, Vowst (SER109), Rebyota (RBX2660), and monoclonal antibody. NMA showed that FMT by LGI had the highest efficacy in treating rCDIs with an odds ratio (95% confidence interval) of 32.33(4.03, 248.69) compared with placebo. FMT by UGI also showed high efficacy, whereas the efficacy comparison between FMT by LGI and UGI was not statistically significant (ORs) (95% CI), 1.72 (0.65, 5.21). The rankogram and surface under the cumulative ranking curve (SUCRA) also showed FMT by LGI ranked at the top and FMT by UGI ranked second in the curative effect. Conclusion: NMA demonstrates FMT's significant efficacy in rCDI management, regardless of administration route (lower or upper gastrointestinal). Despite its significant benefits, FMT's safety is a concern due to the lack of standardized FDAcompliant manufacturing and oversight. Microbiota-based therapies also exhibit potential. However, limited research mandates further clinical exploration. Antibiotics, in contrast, display comparatively reduced efficacy in rCDI, potentially linked to disruptions in native gut microflora balance. Systematic Review: identifier CRD42022368435.

    Keywords: Clostridioides difficile, Infection, Intensive Care, randomized controlled trials, Network meta-analysis

    Received: 10 May 2024; Accepted: 07 Oct 2024.

    Copyright: © 2024 Duo, Yang, Zhang, Chen, Cao, Luo, Ye and Pan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Qifa Ye, Zhongnan Hospital, Wuhan University, Wuhan, 430071, Hubei Province, China
    Huaqin Pan, Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.