How oral microbiome therapy could change C. diff treatment

Paul Feuerstadt, MD, and Louis Korman, MD, spoke with Becker's about how a study published in The New England Journal of Medicine could change how the gastroenterology industry treats Clostridioides difficile.

The two physicians participated in the study, which showed that oral microbiome therapy SER-109 could be helpful in fighting recurrent C. diff.

Question: How do you think the findings from this study will affect the way the industry treats Clostridioides difficile?

Dr. Paul Feuerstadt: The SER-109 study was the first phase 3 clinical trial to publish their results in manuscript form considering a microbiota-based live biotherapeutic treatment. This is exciting because we believe the future of therapeutics for many diseases might involve this type of manipulation of the microbiota. In the case of C. difficile, we clearly understand the deficiency that SER-109 replaces. The therapy showed excellent results in clinical practice through the significant difference in rates of recurrence seen in the population with recurrent C. difficile infection, but also with the basic science considerations with the alterations of the microbiota presented within the study. It is awesome when form fits function in science and this translates to better outcomes for patients.

Dr. Louis Korman: It's going to change it completely, because C. difficile is really common in people who've gotten antibiotics and who are older. What happens when you get C. difficile is that you kill the bacteria with antibiotics, but spores remain, so after a few days in certain people the spores germinate, and the C. difficile comes back. It used to be that after a second recurrence, you would send the patient for a fecal transplant, which required getting the material and having the patient go through a full colonoscopy. At one point, the FDA banned the use of fecal transplants, and there was such an outcry because there was not really another effective treatment available. The FDA basically made an exception. With this therapy, what you're doing is replenishing the good bacteria, which helps to keep C. difficile from colonizing. With the results we're seeing from this study, it looks very promising.


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