Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis
Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis
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DOI：
10.1212/wnl.0000000000007186
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发表时间：
2019-03-26
期刊：
影响因子：
9.9
通讯作者：
Kullberg, Bart Jan
中科院分区：
文献类型：
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作者：
Berende, Anneleen;ter Hofstede, Hadewych J. M.;Kullberg, Bart Jan
目的探讨长期抗生素治疗是否能改善莱姆病持续症状患者的认知能力。方法收集欧洲持久性莱姆病经验性抗生素研究（PLEASE）试验的数据，这是一项随机、安慰剂对照研究。研究参与者通过了性能效度测试（检测次优努力的措施），并有归因于莱姆病的持续症状。所有患者在12周盲口服方案（强力霉素、克拉霉素/羟氯喹或安慰剂）之前接受2周静脉注射头孢曲松的开放标签方案。在基线和14周、26周和40周后，通过神经心理学测试评估认知表现，包括情景记忆、注意力/工作记忆、语言流畅性、信息处理速度和执行功能的认知领域。结果所有治疗组（n = 239）入组患者的基线特征具有可比性。14周后，两组在所有认知领域的表现均无显著差异（p = 0.49-0.82）。随访时，各时间点未见额外治疗效果（p = 0.35-0.98），组间无差异（p = 0.37-0.93）。与基线相比，患者在14周、26周和40周的几个认知领域表现明显更好，但这并不局限于治疗组。结论：与2周头孢曲松治疗相比，2周头孢曲松治疗后12周多西环素或克拉霉素/羟氯喹治疗并没有使莱姆病引起的持续症状患者的认知表现更好。ClinicalTrials.gov识别码NCT01207739。本研究提供的II类证据表明，与短期抗生素相比，长期抗生素不能提高由螺旋体病引起的持续症状患者的认知能力。
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.