Fidaxomicin better than Vancomycin for treating C. difficile Infection: Study

In terms of clinical cure rates and adverse event rates in Clostridioides difficile infection (CDI) patients, fidaxomicin (FDX) is equivalent to vancomycin (VCM) and yields noticeably greater global cure rates and lower recurrence rates, says an article published in the Journal of Infection and Chemotherapy.

As a new therapeutic substitute for vancomycin against Clostridioides difficile infection, fidaxomicin has drawn a lot of interest. However, there is insufficiently strong data to support the superiority and effectiveness profile of FDX. To explain the superiority of FDX for CDI therapy by a systematic review and meta-analysis, Sho Tashiro and colleagues undertook this study.

Patients with CDI were the subject of a meta-analysis of randomized controlled trials (RCTs) that assessed the effectiveness and safety of FDX and VCM. For papers released up through October 15, 2021, electronic resources including the Cochrane Library, PubMed, Web of Science, and Clinicaltrials.gov were searched. The main outcome was the overall cure. The clinical cure, recurrence, and adverse event were the secondary objectives. Using the Mantel-Haenszel random-effects model, risk ratios (RRs), risk differences (RDs), and 95% confidence intervals were computed. Using the Cochrane Handbook for Systematic Reviews of Interventions and Assessment Criteria, the risk of bias was evaluated.

The key findings of this study were:

1. This meta-analysis comprised six RCTs.

2. Global cure rates for FDX were much greater than for VCM.

3. Additionally, the clinical cure rates for FDX and VCM were same (P = 0.31).

4. When compared to VCM, FDX had considerably reduced recurrence rates (RR = 0.59, P 0.0001).

5. Additionally, there was no discernible difference in the frequencies of adverse events across the medications (P = 0.41).

6. The inability to identify substantial variations across patient subgroups as a result of small sample numbers is one limitation.

"As a whole, FDX outperforms VCM as a treatment option for Clostridioides difficile infection," concluded the Authors

Reference: 

Tashiro, S., Mihara, T., Sasaki, M., Shimamura, C., Shimamura, R., Suzuki, S., Yoshikawa, M., Hasegawa, T., Enoki, Y., Taguchi, K., Matsumoto, K., Ohge, H., Suzuki, H., Nakamura, A., Mori, N., … Kunishima, H. (2022). Oral fidaxomicin versus vancomycin for the treatment of Clostridioides difficile infection: A systematic review and meta-analysis of randomized controlled trials. In Journal of Infection and Chemotherapy (Vol. 28, Issue 11, pp. 1536–1545). Elsevier BV. https://doi.org/10.1016/j.jiac.2022.08.008