Thursday, June 2, 2016

Divide deepens over treatment of persistent Lyme disease symptoms

Divide deepens over treatment of persistent Lyme disease symptoms

Weeks after a study debunks use of long-term antibiotics, state legislators approve a measure requiring insurance providers to pay for it.

Some comments on the study design and findings made by a reader of the study who is based in the UK: 

The Berende (Netherlands) study:

a)      Of 1200 people screened  284 were included in the study and 212 completed.
b)      Most patients (87-90%) had been treated multiple times with antibiotics before the study. 
c)       All participants immediately received 2 weeks of IV ceftriaxone and were then assigned into one of three groups for doxycycline, clarithromycin plus hydroxychloroquine, or placebo.
d)      The three groups were treated and re-evaluated using RAND SF-36 self-assessment, at 12 weeks, 26 weeks, 40 weeks and 52 weeks after treatment.
There were no statistical differences in quality of life scores shown in the paper. 

Maybe this would be expected after IV ceftriaxone. 

Relapse and decline in quality of life may be more common with patients given the typical short course doxycycline treatment.

The only data showing outcome over time (Fig 2) tracks only the physical component of the SF-36 data. 

RAND SF-36 may have limitations for quantifying Lyme disease symptoms. 
 The 36 questions can be repetitive. 

For example: Did you feel full of pep?  Did you have a lot of energy? Did you feel tired? Did you feel worn out?

Or vague:  I feel as healthy as anyone I know.  

Or non-specific: For example the pain questions do not discriminate between arthralgia's and myalgia's, or headache.
The complex  neurological symptoms including peripheral neuropathy, cognitive dysfunction, neuropsychiatric problems etc are not specifically scored in this system.

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