Steve
06-13-2001, 01:24 PM
Lyme disease rethought
Wednesday, June 13, 2001
NEW YORK TIMES NEWS SERVICE
Lyme disease is very difficult to catch, even from a deer tick in a
Lyme-infested area, and it can easily be stopped in its tracks with two
capsules of an antibiotic, a
new study shows.
Two other studies, financed by the National Institutes of Health,
conclude that prolonged and intensive treatment with antibiotics, a
course of treatment advocated
by a small group of doctors, does nothing for people with symptoms
attributed to chronic Lyme disease.
The three studies, scheduled to be published on July 12 in The New
England Journal of Medicine, were released yesterday because the
journal's editors thought
that they were so important, with the onset of summer and its
accompanying fear of Lyme disease.
These findings are in keeping with the assertions of researchers
who say that in most cases such symptoms have nothing to do with the
disorder.
“This is reassuring information for people who make decisions based
on evidence,” said Dr. Jeffrey M. Drazen, the journal's editor in chief.
Researchers, both those associated with the studies and others,
said they hoped the studies would alleviate what they called inflated
public fear of Lyme disease,
which is widely seen as a grave illness that is easy to catch.
In 1999, there were 16,019 cases reported to the federal Centers
for Disease Controll and Prevention, most of them in the Northeast.
Dr. Leonard H. Sigal, a Lyme disease expert at the University of
Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical Center
in New
Brunswick, who was not associated with the studies, said the message was
that “Lyme disease, although a problem, is not nearly as big a problem
as most people
think.”
The study to see whether a single dose of doxycycline could prevent
Lyme disease was directed by Dr. Robert B. Nadelman, a professor of
medicine at New
York Medical College and attending physician at the Westchester Medical
Center in Valhalla, N.Y.
Nadelman said many doctors, worried about Lyme disease, were giving
10- to 21-day courses of the antibiotic to people who had found deer
ticks on their
bodies, in hope of stopping an infection.
“They would be treating people as if they actually had the
disease,” he said. He and his colleagues wondered if one dose would be
enough. They recruited 482
people in Westchester County, N.Y., where the incidence of Lyme disease
is among the highest in the world. All had found deer ticks on their
bodies, and
entomologists had identified the insects.
Half got a single dose of doxycycline, taken as two capsules, and
the others got two dummy capsules for comparison. The investigators
found that the drug did
prevent Lyme disease: just 0.4 percent of those who took the capsule
contracted the disease. But even if people did not get any treatment,
their chances of getting
Lyme disease when deer ticks were found on them, even in Westchester
County, were just 3 percent.
Dr. Eugene Shapiro of Yale University School of Medicine, who wrote
an accompanying editorial, noted that the antibiotic often caused
nausea, vomiting and
abdominal pain, and almost no one who took it would have gotten Lyme
disease anyway. People who are bitten can watch the site where the tick
fed, he added,
and if they develop a rash within the next few weeks, they can take a
full course of antibiotics.
“Give that person 10 to 21 days of antibiotics and they will be
fine,” Shapiro said.
Sigal agreed. Deer ticks crawl around the body for hours before
settling down to feed, he added, and during that time they are easily
washed off with a cloth.
And, he said, “even if you get the disease it is easily treatable and it
is curable.”
But Dr. Jesse L. Goodman, a Lyme disease expert at the University
of Minnesota, said some people were so horrified by the possibility of
getting Lyme disease
that even a 3 percent risk was too much. “As a physician, I could
respect that,” he said, adding that he would offer those people a
doxycycline pill.
Lyme disease researchers emphasized, however, that previous studies
had shown that most people with the infection got better on their own,
even without taking
antibiotics.
And while a small percentage of people develop serious symptoms,
such as arthritis or heart disorders, even the vast majority of them get
better on their own,
these researchers said.
Dr. Raymond Dattwyler, director of the Lyme Disease Center at the
State University of New York at Stony Brook, said the typical Lyme
disease patient had a
rash but no other symptoms, took an antibiotic and was cured.
The two other studies being published addressed the treatment of
people who had Lyme disease and later developed symptoms such as
fatigue, aches and pains,
and memory loss. Both were conducted by Dr. Mark S. Klempner of Boston
University School of Medicine and his colleagues.
One study enrolled patients who had antibodies to the Lyme disease
micro-organism, Borrelia burgdorferi, which indicated that they had been
infected.
The other enrolled patients who no longer had antibodies but had
had documented cases of Lyme disease. Half of the patients in each study
received an
intravenous antibiotic, ceftriaxone, for a month, followed by oral
doxycycline for 60 days, and the others received a dummy medication.
The question was, would this intensive antibiotic treatment make
the patients better? The studies were meant to enroll 260 patients but
they ended early, after
enrolling 129 patients, because an independent committee overseeing them
said it had become clear that the antibiotics were no more effective
than the placebos.
Shapiro said he was not surprised. A small but very vocal group of
doctors and patients, Shapiro added, insist that symptoms such as
fatigue and memory loss
after bouts with Lyme disease are caused by chronic infection with the
disease organism. But those symptoms are very common, he said, leading
him to ask whether
they have some other cause.
“Whatever is going on with these patients, if it is unresponsive to
antibiotics, it is unlikely that it is untreated Lyme disease,” he said.
But some who have treated hundreds of patients with long-term
antibiotics, such as Dr. Sam L. Donta of Boston University Medical
Center, said they were not
convinced. The antibiotics in the studies were not given for a long
enough time, he said, and he would have chosen different drugs. All the
studies may have showed,
he said, is “that this particular treatment doesn't work.”
Wednesday, June 13, 2001
NEW YORK TIMES NEWS SERVICE
Lyme disease is very difficult to catch, even from a deer tick in a
Lyme-infested area, and it can easily be stopped in its tracks with two
capsules of an antibiotic, a
new study shows.
Two other studies, financed by the National Institutes of Health,
conclude that prolonged and intensive treatment with antibiotics, a
course of treatment advocated
by a small group of doctors, does nothing for people with symptoms
attributed to chronic Lyme disease.
The three studies, scheduled to be published on July 12 in The New
England Journal of Medicine, were released yesterday because the
journal's editors thought
that they were so important, with the onset of summer and its
accompanying fear of Lyme disease.
These findings are in keeping with the assertions of researchers
who say that in most cases such symptoms have nothing to do with the
disorder.
“This is reassuring information for people who make decisions based
on evidence,” said Dr. Jeffrey M. Drazen, the journal's editor in chief.
Researchers, both those associated with the studies and others,
said they hoped the studies would alleviate what they called inflated
public fear of Lyme disease,
which is widely seen as a grave illness that is easy to catch.
In 1999, there were 16,019 cases reported to the federal Centers
for Disease Controll and Prevention, most of them in the Northeast.
Dr. Leonard H. Sigal, a Lyme disease expert at the University of
Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical Center
in New
Brunswick, who was not associated with the studies, said the message was
that “Lyme disease, although a problem, is not nearly as big a problem
as most people
think.”
The study to see whether a single dose of doxycycline could prevent
Lyme disease was directed by Dr. Robert B. Nadelman, a professor of
medicine at New
York Medical College and attending physician at the Westchester Medical
Center in Valhalla, N.Y.
Nadelman said many doctors, worried about Lyme disease, were giving
10- to 21-day courses of the antibiotic to people who had found deer
ticks on their
bodies, in hope of stopping an infection.
“They would be treating people as if they actually had the
disease,” he said. He and his colleagues wondered if one dose would be
enough. They recruited 482
people in Westchester County, N.Y., where the incidence of Lyme disease
is among the highest in the world. All had found deer ticks on their
bodies, and
entomologists had identified the insects.
Half got a single dose of doxycycline, taken as two capsules, and
the others got two dummy capsules for comparison. The investigators
found that the drug did
prevent Lyme disease: just 0.4 percent of those who took the capsule
contracted the disease. But even if people did not get any treatment,
their chances of getting
Lyme disease when deer ticks were found on them, even in Westchester
County, were just 3 percent.
Dr. Eugene Shapiro of Yale University School of Medicine, who wrote
an accompanying editorial, noted that the antibiotic often caused
nausea, vomiting and
abdominal pain, and almost no one who took it would have gotten Lyme
disease anyway. People who are bitten can watch the site where the tick
fed, he added,
and if they develop a rash within the next few weeks, they can take a
full course of antibiotics.
“Give that person 10 to 21 days of antibiotics and they will be
fine,” Shapiro said.
Sigal agreed. Deer ticks crawl around the body for hours before
settling down to feed, he added, and during that time they are easily
washed off with a cloth.
And, he said, “even if you get the disease it is easily treatable and it
is curable.”
But Dr. Jesse L. Goodman, a Lyme disease expert at the University
of Minnesota, said some people were so horrified by the possibility of
getting Lyme disease
that even a 3 percent risk was too much. “As a physician, I could
respect that,” he said, adding that he would offer those people a
doxycycline pill.
Lyme disease researchers emphasized, however, that previous studies
had shown that most people with the infection got better on their own,
even without taking
antibiotics.
And while a small percentage of people develop serious symptoms,
such as arthritis or heart disorders, even the vast majority of them get
better on their own,
these researchers said.
Dr. Raymond Dattwyler, director of the Lyme Disease Center at the
State University of New York at Stony Brook, said the typical Lyme
disease patient had a
rash but no other symptoms, took an antibiotic and was cured.
The two other studies being published addressed the treatment of
people who had Lyme disease and later developed symptoms such as
fatigue, aches and pains,
and memory loss. Both were conducted by Dr. Mark S. Klempner of Boston
University School of Medicine and his colleagues.
One study enrolled patients who had antibodies to the Lyme disease
micro-organism, Borrelia burgdorferi, which indicated that they had been
infected.
The other enrolled patients who no longer had antibodies but had
had documented cases of Lyme disease. Half of the patients in each study
received an
intravenous antibiotic, ceftriaxone, for a month, followed by oral
doxycycline for 60 days, and the others received a dummy medication.
The question was, would this intensive antibiotic treatment make
the patients better? The studies were meant to enroll 260 patients but
they ended early, after
enrolling 129 patients, because an independent committee overseeing them
said it had become clear that the antibiotics were no more effective
than the placebos.
Shapiro said he was not surprised. A small but very vocal group of
doctors and patients, Shapiro added, insist that symptoms such as
fatigue and memory loss
after bouts with Lyme disease are caused by chronic infection with the
disease organism. But those symptoms are very common, he said, leading
him to ask whether
they have some other cause.
“Whatever is going on with these patients, if it is unresponsive to
antibiotics, it is unlikely that it is untreated Lyme disease,” he said.
But some who have treated hundreds of patients with long-term
antibiotics, such as Dr. Sam L. Donta of Boston University Medical
Center, said they were not
convinced. The antibiotics in the studies were not given for a long
enough time, he said, and he would have chosen different drugs. All the
studies may have showed,
he said, is “that this particular treatment doesn't work.”