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Berende A, Ter Hofstede HJM, Vos FJ, Vogelaar ML, van Middendorp H, Evers AWM, Kessels RPC, Kullberg BJ. Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis. Neurology 2019; 92:e1447-e1455. [PMID: 30796143 PMCID: PMC6453770 DOI: 10.1212/wnl.0000000000007186] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate whether longer-term antibiotic treatment improves cognitive performance in patients with persistent symptoms attributed to Lyme borreliosis. Methods Data were collected during the Persistent Lyme Empiric Antibiotic Study Europe (PLEASE) trial, a randomized, placebo-controlled study. Study participants passed performance-validity testing (measure for detecting suboptimal effort) and had persistent symptoms attributed to Lyme borreliosis. All patients received a 2-week open-label regimen of intravenous ceftriaxone before the 12-week blinded oral regimen (doxycycline, clarithromycin/hydroxychloroquine, or placebo). Cognitive performance was assessed at baseline and after 14, 26, and 40 weeks with neuropsychological tests covering the cognitive domains of episodic memory, attention/working memory, verbal fluency, speed of information processing, and executive function. Results Baseline characteristics of patients enrolled (n = 239) were comparable in all treatment groups. After 14 weeks, performance on none of the cognitive domains differed significantly between the treatment arms (p = 0.49–0.82). At follow-up, no additional treatment effect (p = 0.35–0.98) or difference between groups (p = 0.37–0.93) was found at any time point. Patients performed significantly better in several cognitive domains at weeks 14, 26, and 40 compared to baseline, but this was not specific to a treatment group. Conclusions A 2-week treatment with ceftriaxone followed by a 12-week regimen of doxycycline or clarithromycin/hydroxychloroquine did not lead to better cognitive performance compared to a 2-week regimen of ceftriaxone in patients with Lyme disease–attributed persistent symptoms. ClinicalTrials.gov identifier NCT01207739. Classification of evidence This study provides Class II evidence that longer-term antibiotics in patients with borreliosis-attributed persistent symptoms does not increase cognitive performance compared to shorter-term antibiotics.
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Affiliation(s)
- Anneleen Berende
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands.
| | - Hadewych J M Ter Hofstede
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Fidel J Vos
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Michiel L Vogelaar
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Henriët van Middendorp
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Andrea W M Evers
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Roy P C Kessels
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
| | - Bart Jan Kullberg
- From the Department of Medicine (A.B., H.J.M.t.H., F.J.V., B.J.K.), Radboud Center for Infectious Diseases (A.B., H.J.M.t.H., F.J.V., B.J.K.), and Department of Medical Psychology (M.L.V., H.v.M., A.W.M.E., R.P.C.K.), Radboud University Medical Center; Department of Medicine (F.J.V.), Sint Maartenskliniek, Nijmegen; Institute of Psychology (H.v.M., A.W.M.E.), Health, Medical, and Neuropsychology Unit, Leiden University; and Donders Institute for Brain, Cognition and Behaviour (R.P.C.K.), Radboud University, Nijmegen, the Netherlands
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