Is Suppressing Immunity Harmful to Lyme Disease Patients?
Suppressing immunity may complicate Lyme disease recovery
TNF inhibitors were linked to higher treatment failure rates
Some patients required retreatment after Lyme symptoms returned
Investigators examined whether immune-suppressing medications affected Lyme disease outcomes and found higher rates of dissemination and treatment failure among patients receiving TNF-α inhibitors, raising questions about persistent Lyme disease mechanisms in patients whose symptoms recur despite treatment.
The study compared 16 individuals with Lyme disease receiving TNF-α inhibitors with 32 controls. All patients had confirmed early Lyme disease with an erythema migrans rash manifestation.
Participants were treated with immune-suppressing medications including adalimumab, infliximab, etanercept, and golimumab. These drugs were often combined with additional immunosuppressive medications for rheumatic disease (13 patients) or inflammatory bowel disease (3 patients).
Why TNF inhibitors may complicate Lyme disease treatment
Compared with controls, patients receiving immunosuppressive therapy had:
- More frequent comorbidities unrelated to immune-mediated disease (62.5% vs. 25%)
- More symptoms or signs of disseminated Lyme borreliosis (18.8% vs. 0%)
- Higher rates of treatment failure (25% vs. 0%)
Four out of 16 patients receiving immunosuppressive therapy experienced treatment failure. Three of these four patients ultimately required retreatment.
“The immunocompromised patients were also more likely to fail treatment than patients who were not immunocompromised,” writes Maraspin.
A 25% retreatment rate raises questions about whether immune suppression may alter treatment response or disease progression in some patients. These findings also overlap with questions surrounding persistent Lyme disease mechanisms, particularly when symptoms persist after standard treatment.
A relapse-like illness raised concerns after treatment
The fourth patient, a 44-year-old man, remained well until his 6-month follow-up visit.
Seven months after beginning antibiotic treatment, he developed severe arthralgia, fatigue, and back pain.
“7 months after beginning antibiotic treatment he developed severe arthralgia, fatigue and back pain,” writes Maraspin in the Journal of Clinical Medicine.
A specialist could not determine whether his worsening condition reflected recurrent inflammatory disease or relapse-like Lyme symptoms.
Testing showed his IgG antibody response to VlsE borrelial antigens increased from 542.1 AU/mL to 1462.0 AU/mL during this period.
His symptoms improved following retreatment with ceftriaxone.
This case highlights the challenge of determining whether persistent symptoms following treatment reflect immune dysfunction, inflammatory disease, or ongoing infection. Patients with recurrent symptoms may also overlap with issues discussed in post-treatment Lyme disease syndrome and challenges involving delayed Lyme disease diagnosis.
Should Lyme disease patients receiving immunosuppressants be monitored more closely?
The authors recommended close follow-up of patients receiving immune-suppressing medications to determine whether suppressing immunity alters disease progression or treatment response.
These findings raise concerns that suppressing immune responses may influence dissemination, relapse risk, or recovery in some Lyme disease patients. Patients with persistent symptoms after treatment may also require a broader discussion around recovery from Lyme disease and individualized monitoring.
What are the limitations of this study?
- Only 16 immunosuppressed Lyme disease patients were included
- Patients primarily had early Lyme disease with erythema migrans
- The study design cannot prove causation
- Underlying rheumatic and inflammatory diseases may affect outcomes
- Different immunosuppressive drugs may carry different risks
Frequently Asked Questions
Can TNF inhibitors worsen Lyme disease outcomes?
This study found higher rates of dissemination and treatment failure among patients taking TNF-α inhibitors, though larger studies are needed.
Did all immunosuppressed Lyme disease patients fail treatment?
No. Most patients improved, but treatment failure occurred more often compared with controls.
Can Lyme disease relapse while taking immunosuppressive medications?
This study described patients requiring retreatment after recurrence of symptoms, but determining relapse versus inflammatory disease remains difficult.
Should patients taking biologics be monitored differently for Lyme disease?
The study suggests closer follow-up may be reasonable because immunosuppressed patients had higher rates of dissemination and treatment failure.
Can suppressing immunity make Lyme disease harder to diagnose?
Immune suppression may alter symptoms, treatment response, and disease presentation, potentially complicating diagnosis and follow-up.
Clinical Takeaway
Patients requiring immunosuppressive therapy may face additional challenges when diagnosed with Lyme disease. Although most individuals improved, treatment failures and relapse-like illnesses occurred more frequently in patients receiving TNF inhibitors.
Suppressing immunity harmful to Lyme disease patients remains an important clinical question, particularly when symptoms recur after treatment.
Related Articles
These articles explore persistent symptoms, inflammatory responses, and overlapping immune conditions in Lyme disease.
Persistent Lyme infection or inflammatory immune response?
Can Lyme trigger an autoimmune disease?
Persistent Lyme disease mechanisms
Post-treatment Lyme disease syndrome
Recovery from Lyme disease
References
- Maraspin V, Bogovič P, Rojko T, et al. Early Lyme Borreliosis in Patients Treated with Tumour Necrosis Factor-Alfa Inhibitors. J Clin Med. 2019;8(11):1857.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
As far as I am concerned a misdiagnoses of Chrohn’s disease which was totally wrong and the introduction of IV steroids with follow up 60mg. prednisone for months and months is what ruined my life. By suppressing my immune system my neurological lyme got so severe that the following occurred. Difficulty breathing, difficulty swallowing, increased myoclonus(jerking of limbs involuntarily), felt like I was going to have a full blown seizure, tinnitus got much worse. If I could have found an open window in that hospital I would have jumped! After refusing feeding tubes because they had no idea what the hell was wrong with me I pleaded with my wife to get me a hospital bed at home and that’s where I lay for 2 years.
After leaving the hospital my bowel motility shut down for 12 days, muscle twitching increased dramatically, severe headaches. Upon flouroscopy, laprascopic abdominal surgery it was determined there was no Chrohn’s disease. The great imitator hit me hard. Thankfully a gastroenterologist determined that I just had a severe irritable bowel more than likely from nerves irritated to the bowel from Lyme. He weaned me off steroids slowly but it had done its damage to me. I don’t know about other Lyme patients but after what I have been through from 1993 to this day I would stay away from anything that lowered my immune system.
I was diagnosed with MS. Took immunosuppressants for two years before stopping against Dr advice. I went downhill so fast I knew there was something else happening. Three more years passed before I got an out of country Lyme diagnosis. Sadly my neurologist could have this study in his hands and would have still told me I need to keep on his immunosuppressant treatment plan.
My daughter who had Lyme was prescribed prednisone because she always had swollen glands and a sore throat. (chronic EBV) The next twelve years were hell for her and then she died.
We need more research in this area. I shared the finding in this Blog to encourage more research.
How should someone treat something like lupus?
The treatment often consists of medications to suppress the immune system. There are a growing number of treatments available to rheumatologist. Lupus can be difficult to diagnosis in some patients. I have had some patients where treatment for Lyme disease has been helpful.
In a chronic Lyme/TBD patient diagnosed with autoimmune disease (Lupus, Sjogren’s, etc) where both diseases need treatment concurrently how do you balance the need for DMARDS like methotrexate (and possibly anti TNF meds)
There are treatments to suppress the immune system. Rheumatologists have a growing number of choices.
It’s challenging to find a rheumatologist that believes in chronic TBD’s
I was in remission for 24 years after being treated for 14 months of Iv antibiotics. I had an occasional flare-up which I treated with natural immune supporters and diet. Last year I went to the hospital for chest pains and they gave me Pregnesone an I’ve been sick ever since. I have Uticaria welts all over my body with itching and pain. I have bouts where I can’t breathe. The first thing they want to do is put me back on Prednisone and that’s what caused me to go out of remission!
I’ve got knee pain so bad now I can’t walk, confusion, dizziness, chest pain and irregular heartbeat, and excruciating headaches
It’s exactly the same symptoms I had when I first got bit… Never never take this stuff if you have Lymes!
I have developed joint pain and stiffness suddenly over last 3 to weeks. My docs say polymyalgia rheumatica. Hands, fingers, knees, feet. Ive had tick butes bur no rash. Rt eye droop at times. I take remicade, for pyoderma, actemra fot giant cell and methotrxate. Would you recommend lyme test and do drugs affect results?
Polymyalgia Rheumatica and Lyme disease look alike. I typically look a second time at a tick borne illness even if my patients respond to steroids.
I am presenting with signs of Lyme after a tick bite in June. No rash and IGG/IGM test was negative. Is it possible that I have Lyme?
The tests are not as reliable as I would like. I have to look for other illnesses if the IgG/IgM are negative. I also look for evidence of co-infections. Lastly, I often have to use clinical judgment if the tests are negative and I can’t find another answer.