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 The new study, known as PLEASE, was the largest ever done in
patients with chronic symptoms following a Lyme infection. It was
designed to see if either of two antibiotic regimens might make a
difference. They didn't.
After 12 weeks of therapy with the antibiotic doxycycline, 86
volunteers taking a health status questionnaire logged a score of 35
on a scale of 15 to 61, with 61 being the highest quality of life.
With 12 weeks of treatment with the antibiotic combination
clarithromycin and hydroxychloroquine, the average score of 96
patients was 35.6. Twelve weeks of placebo therapy produced an
average score of 34.8 in the remaining patients.
"The patients reported no benefit of prolonged antibiotics on any of
the scales compared to those who received placebo," said senior
author Dr. Bart Jan Kullberg, a professor of medicine and infectious
disease at Radboud University Medical Center in Nijmegen, the
Netherlands.
The findings, published in New England Journal of Medicine, show
that an active Lyme infection is not causing the symptoms of pain,
fatigue, disrupted sleep and a loss of mental acuity that can
persist in 10 percent to 20 percent of patients who develop the
disease.
In 2014, the United States had 25,359 confirmed cases of Lyme,
according to the Centers for Disease Control and Prevention. The
disease is typically cured by short-term antibiotic therapy.
But when it comes to persistent symptoms, "we don't really know what
is the cause of this syndrome," Kullberg told Reuters Health. "It
could be an immune response to the prior infection, sensitization to
the infection or genetic variation that makes them sensitive to
prolonged symptoms after an infection. But the answer may not be
found in prescribing a prolonged course of antibiotics."
Previous studies have shown the same thing and "this is sort of a
further nail in the coffin in the controversy over chronic Lyme
disease, or whatever you want to call it when people who have had
Lyme disease have residual symptomatology," said Dr. Charles
Ericsson, head of clinical infectious diseases at McGovern Medical
School at UTHealth and a member of the medical staff at Memorial
Hermann-Texas Medical Center in Houston.
"You can treat the inciting agent until the cows come home and
nothing will change," Ericsson, who was not involved in the
research, told Reuters Health. "You have to find a way to control
this disregulated immune system."
He likened it to chronic fatigue syndrome, where doctors seem no
closer to finding a cause, yet, "there's something going on there."
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"We clearly need more research into how to deal with patients with
this disease," Ericsson said.
At the start of the test, all volunteers received two weeks of
intravenous antibiotic therapy with the drug ceftriaxone to clear
any active short-term infection they might have. The patients had
typically already undergone two courses of antibiotic therapy to get
rid of their symptoms, which had persisted for a median of two to
three years.
By the end of the study, patients in all three groups reported less
fatigue and said they felt better physically and mentally, but the
improvements were not significantly greater in either group that
received active medication.
And the quality of life they had in the end was "not different from
patients with cancer or rheumatoid arthritis," Kullberg said.
"In addition, no significant changes over time were observed during
the 26-week follow-up after the end of the treatment period in any
of the study groups," the researchers concluded.
The only serious side effects showed up when ceftriaxone was used
for the first two weeks.
"Although the side effects were mostly minor, 68.6 percent of the
patients reported at least one adverse reaction that was thought to
be drug related, which should lessen the temptation among physicians
to prescribe longer courses of antibiotics just in case they might
help," write Drs. Michael Melia and Paul Auwaerter of Johns Hopkins
University School of Medicine in Baltimore in a Journal editorial.
Lyme disease in Europe is caused by a different species of bacteria
than in North America.
SOURCE: http://bit.ly/1pOqFBw New England Journal of Medicine,
online March 30, 2016.
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