Headlines
As reported by The Hartford Courant, October 11, 2007.
Debate Deepens Over Lyme Treatment
New Study Focuses on Patients Not Aided By Antibiotic Therapy
By William Hathaway
Advocates for Lyme disease patients have long argued that extended antibiotic therapy is necessary to treat lingering and often debilitating effects of the disease, but another study has cast serious doubts about whether the treatment should be recommended.
This time the study was conducted by a scientist who receives extensive support from the same Lyme groups who advocate extended antibiotic therapy: Dr. Brian Fallon, director of the Center for Neuroinflammatory Disorders and Biobehavioral Medicine at Columbia University.
Fallon reported Wednesday, in the online edition of the journal Neurology, that the Lyme patients who had persistent neurological symptoms and received 10 weeks of the intravenous antibiotic ceftriaxone showed no more cognitive improvement at the trial than those who received a placebo.
Fallon did report in the study of 37 previously treated Lyme patients that those who received additional antibiotic treatments did show cognitive improvement while receiving treatment, but he also found that the positive effect disappeared after 24 weeks.
While some patients reported less pain at the completion of the trial, more than one in four subjects reported complications from IV therapy.
That led Fallon, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University which receives extensive support from Lyme disease support groups, to conclude that "treatment strategies that are safer and more durable are needed."
He said treatment options should be left up to doctors. Fallon added that the study does show that antibiotics have an effect, however transitory, and that more research is needed to explain why.
"I hope the article achieves one main goal, which is to demonstrate to the academic community that some patients with previously treated Lyme can benefit from antibiotic therapy," Fallon said.
However, other doctors contend the study validates three other rigorous studies that concluded long-term antibiotic therapy is not warranted for people who complain of persistent symptoms attributed to Lyme.
"Lyme can present special problems, but those case are rare," said Dr. Henry Feder Jr., author of a review published last week in the New England Journal of Medicine that argues there is no scientific evidence to support long-term antibiotic treatment for suspected Lyme disease patients.
"Whatever is going on in this study, it is certainly not dramatic," Feder said. "It may be statistically beneficial for a period, but it is not clinically relevant."
Diane Blanchard, president of Time for Lyme, a Greenwich-based Lyme patient advocacy group that has made contributions to Fallon's lab, said antibiotics do have impact on the conditions of people suffering from pain and mental confusion. Given the severity of symptoms, the continued use of antibiotics is warranted.
"IV therapy is not desirable, but if it is the only way for us to get to a certain threshold, what is the downside if you are reclaiming part of your brain?" Blanchard said.
"The study actually shows more treatment is necessary," said Dr. Raphael Stricker, president of the International Lyme and Associated Diseases Association, a patient advocacy group. "What isn't acceptable is doctors who say, `Sorry we can't help you.' That is just wrong."
However, an editorial in the journal Neurology concluded the Fallon study and previous studies prove it is time to find treatments other than antibiotics to treat people with persistent Lyme-like symptoms.
"Clearly, enough is enough," wrote Dr. John J. Halperin, professor of neuroscience at New York University Medical School and director of neuroscience at the Atlantic Health Systems.
However, the debate on Lyme treatment is not expected to end soon. The Greater Hartford Lyme Disease Support & Action Group has promised to picket Feder at the University of Connecticut Health Center on Friday, saying Feder and other mainstream doctors have ignored scientific data suggesting that Lyme bacterium can survive initial three-week antibiotic regimens.