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- Title
Oral Doxycycline Compared to Intravenous Ceftriaxone in the Treatment of Lyme Neuroborreliosis: A Multicenter, Equivalence, Randomized, Open-label Trial.
- Authors
Kortela, Elisa; Kanerva, Mari J; Puustinen, Juha; Hurme, Saija; Airas, Laura; Lauhio, Anneli; Hohenthal, Ulla; Jalava-Karvinen, Päivi; Nieminen, Tuomas; Finnilä, Taru; Häggblom, Tony; Pietikäinen, Annukka; Koivisto, Mari; Vilhonen, Johanna; Marttila-Vaara, Minna; Hytönen, Jukka; Oksi, Jarmo
- Abstract
Background Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be noninferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB. Methods Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were (1) production of Borrelia burgdorferi– specific antibodies in cerebrospinal fluid (CSF) or serum; (2) B. burgdorferi DNA in the CSF; or (3) an erythema migrans during the past 3 months. Participants were randomized in a 1:1 ratio to receive either oral doxycycline 100 mg twice daily for 4 weeks, or intravenous ceftriaxone 2 g daily for 3 weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months. Results Between 14 September 2012 and 28 December 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n = 104) or ceftriaxone (n = 106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was −3.9 in the doxycycline group and −3.8 in the ceftriaxone group (mean difference, 0.17 [95% confidence interval, −.59 to.92], which is within the prespecified equivalence margins of −1 to 1 units). Participants in both groups improved equally. Conclusions Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB. Clinical Trials Registration NCT01635530 and EudraCT 2012-000313-37.
- Subjects
CEREBROSPINAL fluid examination; CEFTRIAXONE; RESEARCH; CONFIDENCE intervals; LYME neuroborreliosis; DOXYCYCLINE; MEDICAL cooperation; VISUAL analog scale; CENTRAL nervous system infections; TREATMENT effectiveness; RANDOMIZED controlled trials; DESCRIPTIVE statistics; STATISTICAL sampling
- Publication
Clinical Infectious Diseases, 2021, Vol 72, Issue 8, p1323
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciaa217