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Fidaxomicin, Vancomycin Provide Similar C Difficile Initial Cure, Mortality Rates

A meta-analysis suggest the 2 first-line C diff therapies provide similar outcomes, yet differ in recurrent infection risk.

Clostridioides difficile (C difficile) infection therapies fidaxomicin and vancomycin do significantly differ in patient outcomes for initial cure nor mortality, according to findings from a new systematic literature review and meta-analysis.

In new data presented at the Making A Difference in Infectious Disease (MAD-ID) 2021 Annual Meeting, a team of Rhode Island-based investigators reported clinical outcome similarities between the 2 agents across patients treated in 3 different randomized, controlled trials.

That said, the report—presented by J. Xin Liao, PharmD, of the Providence Veterans Affairs Medical Center—did show differentiations in C difficile recurrence among fidaxomicin and vancomycin. The outcome may indicate a more viable first-line treatment strategy to reduce infection recurrence, a key burden among affected C difficile patients.

Current national guidelines recommend either fidaxomicin or vancomycin as the primary treatment of both initial and recurrent C difficile infection, Liao and colleagues wrote. The team sought to interpret opportunities for preference of 1 agent over the other, in order to optimize treatment strategies.

Investigators conducted a systematic literature review of relevant clinical trial databases through until February 2021 for randomized, controlled studies comparing guideline-recommended regimens of vancomycin and fidaxomicin for treating C difficile in adult patients.

They sought primary endpoints of initial cure 2 days following treatment, as well as infection recurrence and mortality at 1 month post-treatment. Their meta-analysis of eligible trials was conducted via random effects modeling.

The team’s final assessment included 3 randomized, controlled trials comprised of 1359 total patients; 668 were treated with fidaxomicin, and 691 were treated with vancomycin. Mean patient age during study was 64.4 years old. More than one-third (38.9%) of patients were classified with severe C difficile infection.

Initial cure was prevalent in 87.2% of patients treated with fidaxomicin, versus 86.5% of patients treated with vancomycin. Mortality at 1 month occurred in 5.8% and 5.9% of treated patients, respectively.

Investigators did observe an approximate 42% decrease in C difficile recurrence likelihood in patients treated with fidaxomicin (RR, 0.58; 95% CI, 0.45 – 0.75; P <.0004) versus vancomycin.

Liao and colleagues indeed concluded that the first line therapies did not significantly differ in initial cure or short-term mortality outcomes for C difficile infection treatment.

“However, fidaxomicin was associated with a lower risk of CDI recurrence compared to vancomycin one-month post-treatment,” they wrote. “These results indicate fidaxomicin may be preferred first-line over vancomycin in minimizing CDI recurrence.”