Kirchoff, Robert W.

Abstract Background Bezlotoxumab is a monoclonal antibody infusion approved to prevent recurrence of Clostridioides difficile infection (CDI). The objective of this study was to explore outcomes associated with bezlotoxumab use at three academic medical centers. Methods A retrospective cohort study was conducted with 180 patients who received bezlotoxumab from May 2018 through November 2023. The primary outcome was recurrence of CDI within 12 weeks of receipt of bezlotoxumab. The study also sought to evaluate risk factors for CDI recurrence in patients who received bezlotoxumab. Results Of the 180 patients who received bezlotoxumab at our institution, 165 were included in the study. Fifteen patients were excluded because they did not improve with standard of care CDI treatment. In the study cohort, 45% were immunosuppressed (n=75), 17% had a solid organ transplant (n=28), and 16% had a history of inflammatory bowel disease (n=27). Ninety-five percent of patients received bezlotoxumab as an outpatient (n=156). Recurrence of CDI within 12 weeks occurred in 16% of patients. Duration from diagnosis of CDI to bezlotoxumab infusion (p=0.022) and having greater than two prior CDI episodes (p=0.032) were statistically significant predictors for CDI recurrence within 30 days. Conclusion Our study demonstrated similar CDI recurrence rates for patients who received bezlotoxumab in a real-world setting compared to previous clinical trials. Patients with CDI may benefit from receiving bezlotoxumab earlier in the course of illness and prior to developing multiple recurrences. Disclosures Robert Orenstein, DO, FACP, Ferring: Advisor/Consultant|Ferring: Honoraria

e24003 Background: Cancer patients undergoing chemotherapy suffer from a variable degree of cancer therapy–related cardiac dysfunction and heart failure (HF). It is known that sodium glucose co-transporter 2 (SGLT2) inhibitors improve outcomes in patients with HF independent of diabetes mellitus and left ventricular ejection fraction; our study aims to investigate the potential benefits of SGLT2 inhibitory therapy specifically in cancer patients undergoing chemotherapy. Methods: We performed an electronic search on PubMed, Embase, and Cochrane, from the inception of databases till January 29, 2024, to identify all the articles that compared the use of SGLT2 inhibitors in adult (≥18 years) with type 2 diabetes mellitus and exposure to cardiotoxic antineoplastic therapy, subsequently diagnosed with cardiomyopathy, heart failure, or LVEF < 40%. The data was extracted and pooled using a random effects model to calculate the odds ratio (OR) with a respective 95% confidence interval (CI). R software (v.4.3) was used for all statistical analyses. Results: Our search identified three observational studies with a total of 3,164 patients (SGLT2- inhibitor group: 1,550; Control group: 1,614). We found that the use of SGLT2 inhibitors was associated with a lower risk of all-cause mortality (OR: 0.25 [0.20, 0.31]; I2 = 16%; p < 0.001), hospitalizations from heart failure (OR: 0.25 [0.10, 0.62]; I2 = 0%; p = 0.003), and acute exacerbation of heart failure (OR: 0.35 [0.27, 0.47]; I2 = 0%; p < 0.001). Conclusions: Our findings suggest a favorable association between the use of SGLT2 inhibitors and reduced mortality, as well as improved cardiac clinical outcomes in cancer patients undergoing chemotherapy. However, further validation through large-scale studies and randomized controlled trials across diverse malignancies is warranted to establish the efficacy of these drugs. [Table: see text]