Efficacy and safety of pharmacological treatments for acute Lyme neuroborreliosis - a systematic review
Efficacy and safety of pharmacological treatments for acute Lyme neuroborreliosis - a systematic review
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DOI：
10.1111/ene.12744
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发表时间：
2015-09-01
影响因子：
5.1
通讯作者：
Meerpohl, J. J.
中科院分区：
文献类型：
--
作者：
Dersch, R.;Freitag, M. H.;Meerpohl, J. J.
背景和目的我们的目的是评估急性莱姆氏疏螺旋体病药物治疗的现有证据，作为循证临床建议的系统综述的基础。方法对Medline、EMBASE、Cochrane图书馆和三个试验注册中心进行系统的文献检索。对随机对照试验(RCT)和非随机研究(NRS)进行评价。使用Cochrane偏差风险工具评估偏差风险。主要结果是残留的神经症状，而次要结果是残疾、生活质量、疼痛、疲劳、抑郁、认知、睡眠、不良事件和脑脊液细胞增多症。结果通过对5779条记录的筛选，纳入8条随机对照试验和8条非随机对照试验。普遍存在偏见的风险很高。多西环素和β-内酰胺类抗生素对4~12个月后残留神经症状的Meta分析[风险比(RR)1.27，95%可信区间(CI)0.98~1.63，P=0.07]或不良事件(RR 0.82，95%CI 0.54~1.25，P=0.35)无统计学意义。与青霉素组相比，头孢噻肟组的神经症状明显减少(RR 1.81，95%CI 1.10~2.97，P=0.02)。青霉素组不良反应明显减少(RR0.56，95%CI0.38~0.84，P=0.005)。结论有关药物治疗急性莱姆氏疏螺旋体病的证据很少，因此不足以推荐β-内酰胺类抗生素优先于多西环素或相反。然而，由于相当大的不精确度，不能排除处理之间的相关差异。没有证据表明延长抗生素治疗的好处。还需要进一步精心设计的试验。个体化的治疗决定应该考虑患者的偏好和个人情况，如既往的过敏反应。
Background and purposeOur aim was to evaluate the available evidence for pharmacological treatment of acute Lyme neuroborreliosis as a basis for evidence-based clinical recommendations in a systematic review.MethodsA systematic literature search of Medline, EMBASE, the Cochrane Library and three trial registries was performed. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were evaluated. Risk of bias was assessed using the Cochrane risk of bias tools. The primary outcome was residual neurological symptoms' whilst the secondary outcomes were disability, quality of life, pain, fatigue, depression, cognition, sleep, adverse events and cerebrospinal fluid pleocytosis. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsAfter screening 5779 records, eight RCTs and eight NRS were included. Risk of bias was generally high. No statistically significant difference was found between doxycycline and beta-lactam antibiotics in a meta-analysis regarding residual neurological symptoms at 4-12months [risk ratio (RR) 1.27, 95% confidence interval (CI) 0.98-1.63, P=0.07] or adverse events (RR 0.82, 95% CI 0.54-1.25, P=0.35). Significantly fewer neurological symptoms for cefotaxime compared with penicillin were found (RR 1.81, 95% CI 1.10-2.97, P=0.02). Adverse events were significantly fewer for penicillin (RR 0.56, 95% CI 0.38-0.84, P=0.005).ConclusionsEvidence regarding pharmacological treatment of acute Lyme neuroborreliosis is scarce and therefore insufficient to recommend preference of beta-lactam antibiotics over doxycycline or vice versa. However, due to considerable imprecision, relevant differences between treatments cannot be excluded. No evidence suggesting benefits of extended antibiotic treatments could be identified. Further well-designed trials are needed. Individual treatment decisions should address patients' preferences and individual conditions like prior allergic reactions.