Clinic of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Eur J Neurol. 2023 Dec;30(12):3780-3788. doi: 10.1111/ene.16034. Epub 2023 Sep 10.
Evidence-based recommendations for treatment of Lyme neuroborreliosis (LNB) should rely on the available literature. As new data emerges, close review and evaluation of the recent literature is needed to build evidence-based recommendations to inform clinical practice and management of LNB. We performed an update of a previous systematic review on treatment of LNB.
A systematic literature search of Medline and CENTRAL was performed for published studies from 2015 to 2023 to update a previous systematic review. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were evaluated. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs; NRS were assessed using the ROBINS-I-tool. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data were integrated into an existing meta-analysis of the available literature.
After screening 1530 records, two RCTs and five NRS with new and relevant data were additionally identified. Meta-analysis showed no statistically significant difference between doxycycline and beta-lactam antibiotics regarding residual neurological symptoms after 12 months. Meta-analysis showed no benefit of extended antibiotic treatment of LNB. Three NRS show no benefit for additional steroid use in LNB with facial palsy.
Additional incorporated recent research corroborates existing guideline recommendations for treatment of LNB. New RCTs add to the certainty of previous analysis showing similar efficacy for doxycycline and beta-lactam antibiotics in LNB. Available evidence shows no benefit for extended antibiotic treatment in LNB. NRS do not suggest a role for steroids in facial palsy due to LNB.
莱姆神经Borreliosis（LNB）治疗的循证建议应依赖于现有文献。随着新数据的出现，需要密切审查和评估最新文献，以建立循证建议，为 LNB 的临床实践和管理提供信息。我们对先前关于 LNB 治疗的系统评价进行了更新。
对 2015 年至 2023 年发表的研究进行了 Medline 和 CENTRAL 的系统文献搜索，以更新先前的系统评价。评估了随机对照试验（RCT）和非随机研究（NRS）。使用 Cochrane 对 RCT 的偏倚风险工具评估偏倚风险；使用 ROBINS-I 工具评估 NRS。使用推荐评估、制定和评估（GRADE）方法评估证据质量。将数据整合到现有的文献荟萃分析中。
筛选出 1530 条记录后，还另外确定了两项 RCT 和五项具有新的相关数据的 NRS。荟萃分析显示，在 12 个月后，多西环素和β-内酰胺类抗生素治疗 LNB 后的残留神经症状方面，无统计学差异。荟萃分析显示，延长 LNB 的抗生素治疗无获益。三项 NRS 显示在 LNB 合并面瘫时，额外使用类固醇无获益。
纳入的最新研究进一步证实了现有指南对 LNB 治疗的建议。新的 RCT 增加了先前分析的确定性，表明多西环素和β-内酰胺类抗生素在 LNB 中的疗效相似。现有证据表明，在 LNB 中，延长抗生素治疗无益。由于 LNB 引起的面瘫，NRS 不建议使用类固醇。
