Trial Outcomes & Findings for Bezlotoxumab Yielded Outcomes by Addressing Personalized Needs in Clostridioides Difficile Infection (NCT NCT05304715)

NCT ID: NCT05304715

Last Updated: 2026-03-04

Results Overview

Unfavorable outcome is defined as the presence of any of: organ dysfunction; CDI relapse; and/or death. Progression into organ dysfunction is defined as any increase of the baseline total SOFA score by at least 2 points. Need for colectomy or admission in the Intensive Care Unit counts also as organ dysfunction. The primary endpoint is tested on Day 40 from start of blind treatment

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

44 participants

Primary outcome timeframe

40 days

Results posted on

2026-03-04

Participant Flow

Participant milestones

Participant milestones
Measure
Placebo
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Bezlotoxumab
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Overall Study
STARTED
22
22
Overall Study
COMPLETED
22
22
Overall Study
NOT COMPLETED
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Bezlotoxumab Yielded Outcomes by Addressing Personalized Needs in Clostridioides Difficile Infection

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Placebo
n=22 Participants
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Bezlotoxumab
n=22 Participants
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Total
n=44 Participants
Total of all reporting groups
Age, Continuous
77 years
n=41 Participants
84.5 years
n=35 Participants
83 years
n=76 Participants
Sex: Female, Male
Female
13 Participants
n=41 Participants
14 Participants
n=35 Participants
27 Participants
n=76 Participants
Sex: Female, Male
Male
9 Participants
n=41 Participants
8 Participants
n=35 Participants
17 Participants
n=76 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
n=41 Participants
0 Participants
n=35 Participants
0 Participants
n=76 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
22 Participants
n=41 Participants
22 Participants
n=35 Participants
44 Participants
n=76 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=41 Participants
0 Participants
n=35 Participants
0 Participants
n=76 Participants

PRIMARY outcome

Timeframe: 40 days

Population: No patient was lost to follow-up, and all of them were included in the final analysis

Unfavorable outcome is defined as the presence of any of: organ dysfunction; CDI relapse; and/or death. Progression into organ dysfunction is defined as any increase of the baseline total SOFA score by at least 2 points. Need for colectomy or admission in the Intensive Care Unit counts also as organ dysfunction. The primary endpoint is tested on Day 40 from start of blind treatment

Outcome measures

Outcome measures
Measure
Bezlotoxumab
n=22 Participants
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Placebo
n=22 Participants
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
The Superiority of Bezlotoxumab Over Placebo to Reduce the Occurence of an Unfavorable Outcome by Day 40.
7 Participants
16 Participants

SECONDARY outcome

Timeframe: 1-40 days

Population: No patient was lost to follow-up, and all of them were included in the final analysis

This is defined as the presentation of organ dysfunction in any of the enrolled patients of each group starting from the day of blind allocation until Day 40.

Outcome measures

Outcome measures
Measure
Bezlotoxumab
n=22 Participants
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Placebo
n=22 Participants
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
The Superiority of Bezlotoxumab Over Placebo Regarding the Time to First Organ Dysfunction.
20.5 days
Interval 4.0 to 40.0
40 days
Interval 29.8 to 40.0

SECONDARY outcome

Timeframe: 1-40 days

Population: No patient was lost to follow-up, and all of them were included in the final analysis

The relapse of CDI is under daily follow-up until Day 40. Relapse is defined as the return of more than three unformed bowel movements in 24 hours with a positive stool toxin test necessitating retreatment.

Outcome measures

Outcome measures
Measure
Bezlotoxumab
n=22 Participants
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Placebo
n=22 Participants
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
The Superiority of Bezlotoxumab Over Placebo to Reduce the Number of Participants Experiencing a CDI Relapse.
0 Participants
1 Participants

SECONDARY outcome

Timeframe: 1-40 days

Population: No patient was lost to follow-up, and all of them were included in the final analysis

Death by day 40 from study enrolment

Outcome measures

Outcome measures
Measure
Bezlotoxumab
n=22 Participants
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Placebo
n=22 Participants
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
The Superiority of Bezlotoxumab Over Placebo to Reduce the Occurence of Death by Day 40.
10 Participants
6 Participants

SECONDARY outcome

Timeframe: 1-40 days

Population: No patient was lost to follow-up, and all of them were included in the final analysis

This is calculated starting from the day of blind allocation until Day 40

Outcome measures

Outcome measures
Measure
Bezlotoxumab
n=22 Participants
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Placebo
n=22 Participants
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
The Superiority of Bezlotoxumab Over Placebo to Reduce the Overall Cost of Hospitalization
4,218.30 Euros
Standard Error 938.9
1,825.20 Euros
Standard Error 275.5

SECONDARY outcome

Timeframe: 1-40 days

Population: Group 1 (n=25) is comprised of patients with a high-risk BEYOND score who did not receive treatment with bezlotoxumab. Group 2 (n=56) is comprised of patients with a low-risk BEYOND score who failed the screening process in the trial.

A high-risk BEYOND score is expected to be associated with an increased risk for unfavorable outcome by day40. This is tested by comparing the number of participants to achieve the primary endpoint of unfavorable outcome by day40 between patients who have failed the screening process in the trial because of a low-risk BEYOND score (n=56); patients with a high-risk BEYOND score who were not enrolled in the study because the score was provided more than 72hours after the initiation of the standard-of-care treatment (n = 3); and patients who were enrolled in the trial and allocated to the placebo arm (n=22).

Outcome measures

Outcome measures
Measure
Bezlotoxumab
n=25 Participants
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Placebo
n=56 Participants
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Validation of the BEYOND Score
19 Participants
19 Participants

Adverse Events

Placebo

Serious events: 9 serious events
Other events: 22 other events
Deaths: 10 deaths

Bezlotoxumab

Serious events: 4 serious events
Other events: 15 other events
Deaths: 6 deaths

Serious adverse events

Serious adverse events
Measure
Placebo
n=22 participants at risk
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Bezlotoxumab
n=22 participants at risk
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Gastrointestinal disorders
Lower gastrointestinal tract bleeding
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Hepatobiliary disorders
Necrotizing cholecystitis
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Infections and infestations
Aspiration pneumonia
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
Infections and infestations
Bacteremia
18.2%
4/22 • Number of events 4 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Infections and infestations
Septic shock
9.1%
2/22 • Number of events 2 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
Infections and infestations
Fungemia
4.5%
1/22 • Number of events 2 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Investigations
Hyponatremia
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Kidney tumor
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Nervous system disorders
Epileptic seizure
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Renal and urinary disorders
Acute kidney injury dialysis
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Respiratory, thoracic and mediastinal disorders
Pulmonary embolism
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)
Respiratory, thoracic and mediastinal disorders
Respiratory failure due to COVID-19
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • Number of events 1 • From enrollment untill end of follow up (days 1-40)

Other adverse events

Other adverse events
Measure
Placebo
n=22 participants at risk
Patients will be treated with 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Bezlotoxumab
n=22 participants at risk
Patients will be treated with bezlotoxumab at a dose of 10mg per kg of body weight (up to maximum of 1000mg) dissolved in 250ml of normal saline 0.9% or 5% dextrose water as single intravenous infusion of one hour within 72 hours from the start of standard-of-care treatment. Standard-of-care treatment will be prescribed to all patients at the discretion of the attending physicians according to local guidelines or to their own decision.
Investigations
Creatine phosphokinase increased
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Investigations
Gamma-glutamyl transpeptidase increased
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Investigations
Aspartate aminotransferase increased
18.2%
4/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Investigations
Alanine aminotransferase increased
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Investigations
Total bilirubin increased
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Investigations
Troponin increased
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hyperglycemia
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hyperkalemia
22.7%
5/22 • From enrollment untill end of follow up (days 1-40)
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hypernatremia
13.6%
3/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hypocalcemia
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hypochloremia
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hypoglycemia
31.8%
7/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hypokalemia
40.9%
9/22 • From enrollment untill end of follow up (days 1-40)
22.7%
5/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hypomagnesemia
18.2%
4/22 • From enrollment untill end of follow up (days 1-40)
13.6%
3/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hyponatremia
31.8%
7/22 • From enrollment untill end of follow up (days 1-40)
27.3%
6/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Hypophosphatemia
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
Metabolism and nutrition disorders
Low uric acid
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Nervous system disorders
Dizziness
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Nervous system disorders
Headache
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Renal and urinary disorders
Acute kidney injury
18.2%
4/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Renal and urinary disorders
Hematuria
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Gastrointestinal disorders
Vomiting
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
General disorders
Bedsore
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Infections and infestations
Aspiration pneumonia
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Infections and infestations
Asymptomatic bacteriuria
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Infections and infestations
Monoarthritis
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Infections and infestations
Perianal abscess
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Infections and infestations
Wound infection
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Investigations
Alkaline phosphatase increased
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Cardiac disorders
Atrial fibrillation
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Cardiac disorders
Chest pain
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Cardiac disorders
Tachycardia
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Blood and lymphatic system disorders
Thrombocytopenia
22.7%
5/22 • From enrollment untill end of follow up (days 1-40)
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
Blood and lymphatic system disorders
Anemia
27.3%
6/22 • From enrollment untill end of follow up (days 1-40)
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
Blood and lymphatic system disorders
INR prolongation
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Blood and lymphatic system disorders
Leukopenia
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
9.1%
2/22 • From enrollment untill end of follow up (days 1-40)
Blood and lymphatic system disorders
Low fibrinogen
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Respiratory, thoracic and mediastinal disorders
Bronchospasm
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Respiratory, thoracic and mediastinal disorders
Solitary pulmonary nodule
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)
Vascular disorders
Hypotension
4.5%
1/22 • From enrollment untill end of follow up (days 1-40)
0.00%
0/22 • From enrollment untill end of follow up (days 1-40)

Additional Information

Evangelos J. Giamarellos-Bourboulis

Hellenic Institute for the Study of Sepsis and 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece

Phone: +302107480662

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place