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Updated: Jul 12, 2026
09:12
A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection
Published on: June 15, 2018
Propensity-Matched Case Control Study of Anti-Interleukin-23 Therapies in Clostridioides difficile Infection
Gregory R Madden1, Jennie Z Ma1
1University of Virginia.
Research Square
|July 10, 2026
Summary
Anti-IL-23 therapy may reduce mortality in Clostridioides difficile infection patients. This study found that prior exposure to anti-interleukin-23 (IL-23) monoclonal antibodies was linked to a significant decrease in 30-day mortality for C. difficile infection.
Area of Science:
- Immunology
- Infectious Diseases
- Gastroenterology
Background:
- Clostridioides difficile infection (CDI) causes significant morbidity and mortality, driven by a toxin-mediated immune response.
- Interleukin-23 (IL-23) driven Th17 responses and neutrophil activation are key contributors to CDI severity and intestinal injury.
- Existing therapies for inflammatory conditions suggest anti-IL-23 monoclonal antibodies may mitigate CDI mortality.
Purpose of the Study:
- To investigate the association between antecedent anti-IL-23 therapy and mortality in patients with CDI.
- To evaluate the impact of anti-IL-23 therapy on 30-day all-cause mortality and 180-day recurrent infection-free survival in CDI patients.
Main Methods:
- A retrospective cohort study utilized the Epic Cosmos electronic health record database (>300 million patients).
- Adult patients with CDI exposed to anti-IL-23 therapy (ustekinumab, guselkumab, tildrakizumab, risankizumab, mirikizumab) within 90 days were propensity score matched (10:1) with unexposed controls.
- Primary outcome was 30-day all-cause mortality, analyzed using multivariable Cox proportional hazards regression, adjusted for ATLAS severity.
Main Results:
- The matched cohort comprised 328 anti-IL-23 exposed patients and 3,155 controls.
- Anti-IL-23 exposure was significantly associated with reduced 30-day mortality (HR 0.341, P=0.042).
- A significant interaction between baseline ATLAS severity and anti-IL-23 efficacy was observed (P=0.029); no difference in 180-day recurrence-free survival was found (HR 0.808, P=0.355).
Conclusions:
- Antecedent anti-IL-23 therapy is associated with a significant reduction in 30-day mortality following CDI.
- Inhibiting IL-23 mediated inflammation may improve CDI outcomes when used alongside standard antibiotics.
- The efficacy of anti-IL-23 therapy may be greatest in high-risk CDI patients, warranting further prospective investigation.
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