Robert Orenstein1, Erik Dubberke2, Robert Hardi3, Arnab Ray4, Kathleen Mullane5, Darrell S Pardi6, Mayur S Ramesh7. 1. Division of Infectious Diseases, Mayo Clinic-Arizona, Phoenix. 2. Department of Medicine, Washington University School of Medicine, St. Louis, Missouri. 3. Chevy Chase Clinical Research, Capital Digestive Care, Maryland. 4. Ochsner Clinic, New Orleans, Louisiana. 5. Section of Infectious Diseases and Global Health, University of Chicago Medicine, Illinois. 6. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. 7. Henry Ford Hospital System, Detroit, Michigan.
Abstract
BACKGROUND: Managing recurrent Clostridium difficile infection (CDI) presents a significant challenge for clinicians and patients. Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent CDI, yet availability of a standardized, safe, and effective product has been lacking. Our aim in this study was to assess the safety and effectiveness of RBX2660 (microbiota suspension), a commercially prepared FMT drug manufactured using standardized processes and available in a ready-to-use format. METHODS: Patients with at least 2 recurrent CDI episodes or at least 2 severe episodes resulting in hospitalization were enrolled in a prospective, multicenter open-label study of RBX2660 administered via enema. Intensive surveillance for adverse events (AEs) was conducted daily for 7 days following treatment and then at 30 days, 60 days, 3 months, and 6 months. The primary objective was product-related AEs. A secondary objective was CDI-associated diarrhea resolution at 8 weeks. RESULTS: Of the 40 patients enrolled at 11 centers in the United States between 15 August 2013 and 16 December 2013, 34 received at least 1 dose of RBX2660 and 31 completed 6-month follow-up. Overall efficacy was 87.1% (16 with 1 dose and 11 with 2 doses). Of 188 reported AEs, diarrhea, flatulence, abdominal pain/cramping, and constipation were most common. The frequency and severity of AEs decreased over time. Twenty serious AEs were reported in 7 patients; none were related to RBX2660 or its administration. CONCLUSIONS: Among patients with recurrent or severe CDI, administration of RBX2660 via enema appears to be safe and effective. CLINICAL TRIALS REGISTRATION: NCT01925417.
BACKGROUND: Managing recurrent Clostridium difficileinfection (CDI) presents a significant challenge for clinicians and patients. Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent CDI, yet availability of a standardized, safe, and effective product has been lacking. Our aim in this study was to assess the safety and effectiveness of RBX2660 (microbiota suspension), a commercially prepared FMT drug manufactured using standardized processes and available in a ready-to-use format. METHODS:Patients with at least 2 recurrent CDI episodes or at least 2 severe episodes resulting in hospitalization were enrolled in a prospective, multicenter open-label study of RBX2660 administered via enema. Intensive surveillance for adverse events (AEs) was conducted daily for 7 days following treatment and then at 30 days, 60 days, 3 months, and 6 months. The primary objective was product-related AEs. A secondary objective was CDI-associated diarrhea resolution at 8 weeks. RESULTS: Of the 40 patients enrolled at 11 centers in the United States between 15 August 2013 and 16 December 2013, 34 received at least 1 dose of RBX2660 and 31 completed 6-month follow-up. Overall efficacy was 87.1% (16 with 1 dose and 11 with 2 doses). Of 188 reported AEs, diarrhea, flatulence, abdominal pain/cramping, and constipation were most common. The frequency and severity of AEs decreased over time. Twenty serious AEs were reported in 7 patients; none were related to RBX2660 or its administration. CONCLUSIONS: Among patients with recurrent or severe CDI, administration of RBX2660 via enema appears to be safe and effective. CLINICAL TRIALS REGISTRATION: NCT01925417.
Authors: Christopher Staley; Matthew J Hamilton; Byron P Vaughn; Carolyn T Graiziger; Krista M Newman; Amanda J Kabage; Michael J Sadowsky; Alexander Khoruts Journal: Am J Gastroenterol Date: 2017-02-14 Impact factor: 10.864
Authors: Julia L Drewes; Alina Corona; Uriel Sanchez; Yunfan Fan; Suchitra K Hourigan; Melissa Weidner; Sarah D Sidhu; Patricia J Simner; Hao Wang; Winston Timp; Maria Oliva-Hemker; Cynthia L Sears Journal: JCI Insight Date: 2019-10-03