Antibiotic Treatment Response in Chronic Lyme Disease: Why Do Some Patients Improve While Others Do Not?

Abstract

There is considerable uncertainty regarding treatment of Lyme disease patients who do not respond fully to initial short-term antibiotic therapy. Choosing the best treatment approach and duration remains challenging because treatment response among these patients varies: some patients improve with treatment while others do not. A previous study examined treatment response variation in a sample of over 3500 patients enrolled in the MyLymeData patient registry developed by LymeDisease.org (San Ramon, CA, USA). That study used a validated Global Rating of Change (GROC) scale to identify three treatment response subgroups among Lyme disease patients who remained ill: nonresponders, low responders, and high responders. The present study first characterizes the health status, symptom severity, and percentage of treatment response across these three patient subgroups together with a fourth subgroup, patients who identify as well. We then employed machine learning techniques across these subgroups to determine features most closely associated with improved patient outcomes, and we used traditional statistical techniques to examine how these features relate to treatment response of the four groups. High treatment response was most closely associated with (1) the use of antibiotics or a combination of antibiotics and alternative treatments, (2) longer duration of treatment, and (3) oversight by a clinician whose practice focused on the treatment of tick-borne diseases.

Disease-Associated Multimolecular Signature in the Urine of Patients with Lyme Disease Detected Using Raman Spectroscopy and Chemometrics

“…They reported that more than 70% of patients referred with “LD” to an academic infectious disease clinic were considered misdiagnosed and >80% of those patients were considered to have received unnecessary antimicrobial therapy. In contrast, another recent study, 27 using data from a patient-derived database, 28 showed that some patients experienced significant benefits from a combination of antibiotic and alternative therapies, and focused medical management.…”

Recent Progress in Lyme Disease and Remaining Challenges

“…A tissue bank was recently launched for post-mortem and surgical samples. Tissue donors have the option to link their MyLymeData registry profile to their tissue sample (339,340).…”

Feature Selection from Lyme Disease Patient Survey Using Machine Learning

“…Our analysis suggests that antibiotic related questions may be the most important in predicting a patient's treatment response for those with persistent Lyme disease. This topic is explored in greater detail in a companion study analyzing the role of specific features identified in the top 30 in connection with treatment response [22].…”

“…In a companion study performed in parallel to this work [22], the authors use more traditional statistical methods and investigative analysis on the MyLymeData dataset. The results of our classification and regression models agree with many of its findings.…”