Title : Comparative effectiveness of different therapies for Clostridioides difficile infection in adults: A systematic review and network meta-analysis of randomized controlled trials
Abstract:
Background: Dániel S. Bednárik Clostridioides difficile infection (CDI) is the most common and serious causes of healthcare-associated diarrhea, with significant morbidity and mortality. The incidence of CDI is increasing worldwide and it is therefore essential to carefully evaluate the efficacy of currently used therapies.
Methods: Potential therapies for the treatment and prevention of CDI were analysed using a network meta-analysis of data from randomised controlled trials published up to 19 August 2024. Data collection was performed in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials databases using a research protocol registered in PROSPERO (CRD4202222371210). The treatments were ranked according to P-score.
Results: We assessed 73 RCTs with 28 interventions, involving 27,959 patients (49.2% female) in five networks. Fecal microbiota transplantation (FMT) was the most effective treatment in terms of the cure rate overall (P-score: 0.9952) and in recurrent cases (P-score: 0.9836). For recurrent cases, fidaxomicin (P-score: 0.67) showed significantly greater efficacy than vancomycin (P-score: 0.37) and tolevamer (P-score: 0.36), while for non-recurrent infections, ridinilazole, fidaxomicin, FMT and nitazoxanide were equally effective. For the prevention of recurrence, ridinilazole (P-score: 0.77) and fidaxomicin (P-score: 0.76) were the most effective. Probiotics were not effective in preventing CDI, with no significant difference between probiotics and placebo (even in old age). There was no difference between oral and colonoscopic routes of administration of FMT.
Conclusion: The superiority of FMT in the treatment of CDI highlights the potential for increased use of FMT in clinical settings. Further research on optimizing FMT protocols and exploring its longterm safety and efficacy in larger samples is needed. Our findings suggest that the preventive use of probiotics might be questioned.
