Is suppressing immunity harmful to Lyme disease patients?
There have only been a few published reports detailing the outcome of treatment on Lyme disease patients who are immunocompromised. Now, a study by Maraspin and colleagues¹ evaluates the impact of tumour necrosis factor-alpha (TNF-α) inhibitors, medications that suppress the immune system, on Lyme disease patients.
The authors compared 16 individuals with Lyme disease receiving TNF-α inhibitors with 32 healthy controls to understand whether suppressing their immunity is harmful. The individuals had confirmed Lyme disease with an erythema migrans rash manifestation. The patients received immune-suppressing medications, which included adalimumab, infliximab, etanercept, golimumab. These were often combined with other immunosuppressant drugs for rheumatic (13 patients) or inflammatory bowel (3 patients) disease.
Investigators found that, when compared to controls, patients receiving immunosuppressants had:
- frequent comorbidities other than immune-mediated diseases (62.5% vs. 25%)
- symptoms/signs of disseminated Lyme borreliosis (18.8% vs. 0%)
- treatment failure (25% vs. 0%.)
In fact, 4 out of 16 (25%) Lyme disease patients treated with immunosuppression therapy failed treatment. Three of these four patients required retreatment. One of them was quite ill.
“The immunocompromised patients were also more likely to fail treatment than patients who were not immunocompromised,” writes Maraspin.
The fourth patient, a 44-year-old man, remained well until his 6-month follow-up visit. But, “7 months after beginning antibiotic treatment he developed severe arthralgia, fatigue and back pain,” writes Maraspin in the Journal of Clinical Medicine.
[bctt tweet=”25% of Lyme disease patients treated with immunosuppression therapy required re-treatment for Lyme disease, according to study findings. ” username=”DrDanielCameron”]A specialist was consulted but could not confirm whether the man had a relapse of rheumatoid arthritis. He remained ill for the next 5 months. And tests revealed his IgG antibody to VlsE borrelial antigens rose from 542.1 to 1462.0 AU/mL.
His symptoms improved following re-treatment with the antibiotic, ceftriaxone.
The authors recommended regular follow-up visits understand whether suppressing immunity harmful to Lyme disease patients?
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Persistent Lyme infection or inflammatory immune response?
References:
- Vera Maraspin, Petra Bogovič, Tereza Rojko, et al. Early Lyme Borreliosis in Patients Treated with Tumour Necrosis Factor-Alfa Inhibitors. J Clin Med. 2019 Nov; 8(11): 1857.
Erin
10/18/2022 (6:25 pm)
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?
Dr. Daniel Cameron
10/19/2022 (12:31 pm)
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.