2008. Real-World Experience of Administration of Bezlotoxumab in an Outpatient Infusion Center Upon Discharge in Recurrent Clostridioides difficile patients

Abstract

Abstract Background Bezlotoxumab is a humanized monoclonal antibody administered as single IV infusion that binds to Clostridioides difficile toxin B. It is currently recommended as a co-intervention in the updated 2021 IDSA guidelines for patients with recurrent C. difficile infection (CDI) in the last 6 months in addition to standard of care (SOC) antibiotics (vancomycin or fidaxomicin) to decrease CDI recurrence. Due to logistical issues and cost restrictions, administration is difficult as part of the inpatient stay. This case series evaluated a novel practice of discharging patients to receive bezlotoxumab immediately upon discharge from our not-for-profit community health system. Methods This was a retrospective chart review of all adult patients who received an outpatient infusion of bezlotoxumab after discharge between June 2019 and January 2022 for recurrent CDI. CDI was defined as ≥ 3 loose stools within 24 hours and a positive stool test for toxigenic C. difficile. The primary objectives were to evaluate the safety of bezlotoxumab in the outpatient setting and the rate of recurrent CDI at 12 weeks and 1 year. Recurrent CDI was defined using the same parameters as initial infection. Results Ten patients received bezlotoxumab in the outpatient setting after discharge and were included. Of the 10 patients, 2 were immunocompromised, 6 had at least stage 2 chronic kidney disease, and 4 required dialysis. All patients had > 1 previous CDI in the past 6 months, ranging between 1-6 with the average being 2.4. The average time to infusion was 9.8 days after starting SOC antibiotics and 80% of patients received treatment within 24 hours of discharge. No patients reported adverse reactions during treatment. One patient with a previous diagnosis of heart failure was readmitted for a heart failure exacerbation 69 days after receiving bezlotoxumab. Two patients and 4 patients experienced CDI recurrence within 12 weeks and 1 year of infusion, respectively. Conclusion Discharging patients to receive bezlotoxumab as an outpatient infusion is a safe and effective way to treat recurrent CDI logistically and may offer a financial advantage to institutions to shift costs to an outpatient payment model. Recurrence rates compared to phase III trials of bezlotoxumab were similar at 12 weeks (20% vs. 16%). Disclosures Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS, biomerieux, Inc.: Honoraria|Merck Pharmaceuticals: Advisor/Consultant|Merck Pharmaceuticals: Honoraria Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|La Jolla: Honoraria|Melinta: Advisor/Consultant|Paratek: Honoraria|Regeneron: Honoraria.