Alterations in Microbial Diversity are Associated with Treatment Success with RBX2660, a Microbiota-Based Drug for the Prevention of Recurrent Clostridium difficile Infection: Results from PUNCH CD 2: a Randomized Double-Blind Placebo-Controlled Trials

Sahil Khanna, MBBS, MS; Gail Hecht, MD; Erik Dubberke,MD, MSPH; Robert Orenstein, DO; Christine Lee, MD; Dale Gerding, MD

Summary

• One dose of RBX2660 administered via enema is more effective than placebo for recurrent CDI
• Responders to RBX2660
  • Distinct microbiome changes from baseline in contrast to those who fail active treatment
• Responders to RBX2660
  • Different microbiota composition than responders to placebo
• Placebo responders demonstrate no changes in microbiota composition after treatment

Conclusions

• RBX2660 administered via enema is an effective treatment for recurrent CDI
• Responders to active therapy have distinct microbiome profiles compared to failures
  • Importance of bacterial engraftment
• Response to active therapy but not to placebo correlates with changes from baseline microbiome
• Changes in microbial profiles after microbiota-based therapies may predict treatment response