Oral fidaxomicin versus vancomycin for the treatment of Clostridioides difficile infection: A systematic review and meta-analysis of randomized controlled trials

医学 荟萃分析 内科学 随机对照试验 不利影响 相对风险 非达霉素 科克伦图书馆 置信区间 临床终点 出版偏见 重症监护医学 万古霉素 生物 细菌 遗传学 金黄色葡萄球菌
作者
Sho Tashiro,Takayuki Mihara,Moe Sasaki,Chiaki Shimamura,Rina Shimamura,Shiho Suzuki,Masahide Yoshikawa,Tatsuki Hasegawa,Yuki Enoki,Kazuaki Taguchi,Kazuaki Matsumoto,Hiroki Ohge,Hiromichi Suzuki,Atsushi Nakamura,N. Môri,Yoshitomo Morinaga,Yuka Yamagishi,Sadako Yoshizawa,Katsunori Yanagihara,Hiroshige Mikamo,Hiroyuki Kunishima
出处
期刊:Journal of Infection and Chemotherapy [Elsevier]
卷期号:28 (11): 1536-1545 被引量:17
标识
DOI:10.1016/j.jiac.2022.08.008
摘要

Fidaxomicin (FDX) has received considerable attention as a novel therapeutic alternative agent to vancomycin (VCM) for Clostridioides difficile infection (CDI). However, the superiority and efficacy profile of FDX are not sufficiently determined by high-quality evidence. This study aimed to clarify the superiority of FDX for CDI treatment through a systematic review and meta-analysis.We conducted a meta-analysis of randomized controlled trials (RCTs) which evaluated the efficacy and safety of FDX and VCM in patients with CDI. Electronic databases (PubMed, Cochrane Library, Web of Science, and Clinicaltrials.gov) were searched for studies published until October 15, 2021. The primary endpoint was global cure. The secondary endpoints were clinical cure, recurrence, and adverse event. Risk ratios (RRs), risk differences (RDs), and 95% confidence intervals were calculated using Mantel-Haenszel random-effects model. The risk of bias was assessed using Cochrane Handbook for Systematic Reviews of Interventions and Assessment Criteria.Six RCTs were included in this meta-analysis. Compared to VCM, FDX was associated with significantly higher global cure rates (RR = 1.18, P < 0.00001; RD = 0.11, 95% CI = 0.07-0.16). In addition, clinical cure rates were comparable between FDX and VCM (P = 0.31). FDX was associated with significantly lower recurrence rates compared to VCM (RR = 0.59, P < 0.0001). In addition, adverse event rates were not significantly different between the drugs (P = 0.41).FDX achieves significantly higher global cure rates and lower recurrence rates and is comparable to VCM in clinical cure rates and adverse event rates in patients with CDI. Collectively, FDX is superior to VCM as a therapeutic agent for CDI.
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