Study: Effective Treatment Significantly Improves HRQoL in Recurrent Clostridioides difficile

Receiving effective treatment for recurrent Clostridioides difficile infection (rCDI) significantly improves health-related quality of life (HRQoL), said researchers.

Using questionnaires from a Danish randomized controlled trial, the researchers found that while HRQoL was negatively affected during an active episode of rCDI, having effective treatment that was followed by rescue fecal microbiota transplantation (FMT), if needed, helped improve HRQoL.

At the start of the study, the untreated patients had an average HRQoL score of 0.675. After receiving 8 weeks of treatment, scores went up by 0.139, with an average score of 0.813. At week 26, scores were up 0.098 from baseline, with an average score of 0.773.

The researchers wrote that their findings showcase the need for close monitoring of patients and for effective treatments for those with recurrent infection, which occurs in 15%-30% of all patients with CDI.

“Evidence on the gain in HRQoL after receiving effective treatment is important for evaluating the effectiveness and cost-effectiveness of alternative treatment strategies,” explained the group. “Precise and relevant quantitative estimates of HRQoL based on preference-based measures are essential for cost-utility analyses in which quality-adjusted life years, combining patients’ HRQoL with the length of time spent in a specific health state, are applied to assess the value gained from a medical therapy.”

While effective treatment consistently increased HRQoL throughout the study, the researchers noted variations in HRQoL changes. By week 8, 80% of patients experienced an increase in HRQoL. By week 26, improvements were significant, albeit slightly lower, with 75% of patients experiencing an increase in HRQoL. Between week 8 and week 26, 35% of patients had an increase in HRQoL while 32.5% had a decrease in HRQoL.

A total of 64 patients were randomized to receive vancomycin, fidaxomicin, or initial vancomycin followed by FMT. At the end of the 26 weeks, 81% of patients receiving vancomycin, 50% of patients receiving fidaxomicin, and 3 % of patients receiving FMT had recurrence and received rescue FMT. The researchers did notice gaps in data throughout follow-ups, with some data missing for 37.5% of patients.

The researchers observed no clear differences in HRQoL changes between the 3 groups during any follow-up point, although they did find a trend toward FMT having larger improvements in HRQoL at week 8 and that fidaxomicin or vancomycin had larger improvements at week 26.

“Our findings can be compared with population norms to assess the differences in HrQoL between the general population and patients cured of rCDI. In a Danish study based on a representative sample of the general population in the North Denmark Region, the average HRQoL among men and women aged 65–74 years was found to be 0.84 and 0.82, respectively,” wrote the researchers.

“The average HRQoL of patients cured of rCDI in this study is slightly lower but seems to approach the HRQoL in the general Danish population. This indicates that it may be possible to increase patients’ average quality of life to near normal with close monitoring of patients and the availability of effective treatments,” they concluded.

Reference

Hammeken L, Baunwall S, Dahlerup J, Hvas C, Ehlers L. Health-related quality of life in patients with recurrent Clostridioides difficile infections. Ther Adv Gastroenterol. Published online April 18, 2022. doi:10.1177/17562848221078441