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CompletedNCT01207739PLEASEUpdated Sep 8, 2016

Persistent Lyme Empiric Antibiotic Study Europe

A Phase 4 interventional study of Doxycycline and Clarithromycin and hydroxychloroquine in Lyme Disease and Borrelia Infection, sponsored by Radboud University Medical Center. Completed at 2 sites in Netherlands. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2016-09-08.

Sponsored by Radboud University Medical Center · Phase 4, Interventional, and Treatment

Phase
Phase 4
Study type
Interventional
Enrollment
280
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The purpose of the study is to establish whether prolonged antibiotic treatment of patients diagnosed with proven or presumed PLD (as endorsed by the international ILADS guidelines) leads to better patient outcome than short-term treatment as endorsed by the Dutch CBO guidelines.

02

Conditions studied

  • Lyme Disease
  • Borrelia Infection

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Keywords

  • Prolonged antibiotic treatment in Lyme disease
  • Doxycycline
  • Clarithromycin
  • Hydroxychloroquine
03

In context

Lyme Disease

91 studies on the registry are indexed under Lyme Disease; 27 are open to participants now.

This study's enrollment of 280 is above the median of 100 across 49 interventional studies indexed under Lyme Disease.

Browse Lyme Disease studies →

Lead sponsor

Radboud University Medical Center is the lead sponsor of 959 studies on the registry; 134 are open to participants now.

Of its 6 completed or terminated interventional studies of FDA-regulated products, 0 (0%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Males or non-pregnant, non-lactating females who are 18 years or older.
  • Women of child-bearing potential must agree to use contraception methods other than oral contraceptives during the study therapy period, since failure of oral contraceptives due to long-term antibiotic use has been described and doxycycline might be teratogenic.
  • Patients with presumed or proven PLD. In this study, clinical suspicion of PLD is defined as complaints of musculoskeletal pain, arthritis or arthralgia, neuralgia or sensory disturbances (such as paresthesias or dysesthesias), neuropsychological or cognitive disorders, and persistent fatigue, that are:

    • temporally related to an episode of erythema migrans or otherwise proven symptomatic Lyme disease (defined as within 4 months after erythema migrans as assessed by a physician, or positive biopsy, PCR, culture, intrathecal B. burgdorferi antibodies), OR
    • accompanied by a positive B. burgdorferi IgG or IgM immunoblot (as defined by strict criteria in line with the European Union Concerted Action on Lyme Borreliosis (EUCALB)), regardless of prior ELISA IgG/IgM screening results.
  • Subjects must sign a written informed consent form.

Exclusion criteria

Exclusion Criteria:

  • Subjects with a known history of allergy or intolerance to tetracyclines, macrolides, hydroxychloroquine or ceftriaxone.
  • Subjects who have had more than 5 days of antimicrobial therapy with activity against B. burgdorferi within the previous 4 weeks.
  • Subjects with a presumed diagnosis of neuroborreliosis (CSF pleocytosis or intrathecal antibody production) for which intravenous antimicrobial therapy is required.
  • Subjects with a known diagnosis of HIV-seropositivity or other immune disorders. (No HIV serologic testing is required for the study).
  • Subjects with positive syphilis serology or signs of other spirochetal diseases.
  • Subjects with moderate or severe liver disease defined as alkaline phosphatase, ALAT, or ASAT greater than 3 times upper limit of normal.
  • Subjects who are receiving and cannot discontinue cisapride, astemizole, terfenadine, barbiturates, phenytoin, or carbamazepine (The concentrations of these drugs may increase during clarithromycin therapy and/or lead to reduced availability of doxycycline).
  • Subjects who are currently enrolled on other investigational drug trials or receiving investigational agents.
  • Subjects who have been previously randomized into this study.
  • Severe physical or psychiatric co-morbidity that interferes with participation in the study protocol, including previous medical diagnosis of rheumatic conditions, chronic fatigue syndrome or chronic pain conditions as well as insufficient command of the Dutch language.
  • Co-morbidity that could (partially) account for the symptoms of the subject (e.g. vitamin B12 deficiency, anemia, hypothyroidism).
05

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
280 participants (actual)

Study arms

  • Active comparator
    Doxycycline

    Drug: Doxycycline

  • Active comparator
    Clarithromycin and hydroxychloroquine

    Drug: Clarithromycin and hydroxychloroquine

  • Placebo comparator
    Placebo

    Drug: Placebo

Interventions

  • DrugDoxycycline

    After open-label i.v. ceftriaxone 2000 mg qd via a peripheral i.v. catheter: oral Doxycycline 100 mg combined with a placebo b.i.d. for 12 weeks

    Also known as: Doxycycline disper, CASnr 564-25-0 (doxycycline); 17086-28-1 (doxycycline monohydraat)

  • DrugClarithromycin and hydroxychloroquine

    After open-label i.v. ceftriaxone 2000 mg qd via a peripheral i.v. catheter: clarithromycin 500 mg combined with hydroxychloroquine 200 mg b.i.d. for 12 weeks

    Also known as: Clarithromycine Mylan, RVG 32619, CASnr 81103-11-9, Hydroxychloroquine; Plaquenil, RVG 00853, CASnr 118-42-3 (hydroxychloroquine); 737-36-4 (hydroxychloroquine sulfate)

  • DrugPlacebo

    After open-label i.v. ceftriaxone 2000 mg qd via a peripheral i.v. catheter: 12 weeks' course of double placebo b.i.d.

06

What researchers measure

Primary outcomes

  1. Global score 36-item Short-form General Health Survey (SF 36)

    Because different operationalizations of the term 'Global score 36-item Short-form General Health Survey (SF 36)' exist, the primary outcome measure is specified here as the 'physical component summary score' (PCS) of the RAND-36 Health Status Inventory (RAND SF-36, Hays 1998), which is similar to the Medical Outcomes Study (MOS) 36-item Short-Form General Health Survey (SF-36). The PCS is also known as the physical health composite score (PHC). This specification has been communicated to the local Ethics Committee on March 1, 2011, and was approved on April 6, 2011.

    Time frame: Week 14

Secondary outcomes

  1. Subscales 36-item Short-form General Health Survey (SF 36)

    After the last comprehensive outcome assessment at week 40, patients are surveyed by post-study questionnaires at week 52 (protocol version 3.8; dated July 17, 2009; final Ethics Committee approval April 29, 2010).

    Time frame: weeks 0, 14, 26, 40 and 52

  2. Actometer recording during 14 days (objective physical activity)

    Time frame: weeks 0, 14 and 40

  3. Measurements of neuropsychological impairment

    Time frame: weeks 0, 14, 26 and 40

  4. Economic evaluation: Questionaire EQ-5D, health consumption and productivity of labour

    After the last comprehensive outcome assessment at week 40, patients are surveyed by post-study questionnaires at week 52 (protocol version 3.8; dated July 17, 2009; final Ethics Committee approval April 29, 2010).

    Time frame: weeks 0, 14, 26, 40 and 52

  5. Fatigue subscale of Checklist Individual Strength (CIS)

    After the last comprehensive outcome assessment at week 40, patients are surveyed by post-study questionnaires at week 52 (protocol version 3.8; dated July 17, 2009; final Ethics Committee approval April 29, 2010).

    Time frame: weeks 0, 14, 26, 40 and 52

07

Study locations

2 sites
  • Radboud University Nijmegen Medical Centre
    Nijmegen, 6500 HB, Netherlands
  • Sint Maartenskliniek
    Nijmegen, 6522 JV, Netherlands
08

References and documents

Publications

  • Berende A, ter Hofstede HJ, Donders AR, van Middendorp H, Kessels RP, Adang EM, Vos FJ, Evers AW, Kullberg BJ. Persistent Lyme Empiric Antibiotic Study Europe (PLEASE)--design of a randomized controlled trial of prolonged antibiotic treatment in patients with persistent symptoms attributed to Lyme borreliosis. BMC Infect Dis. 2014 Oct 16;14:543. doi: 10.1186/s12879-014-0543-y. PubMed 25318999 ↗
  • Berende A, ter Hofstede HJ, Vos FJ, van Middendorp H, Vogelaar ML, Tromp M, van den Hoogen FH, Donders AR, Evers AW, Kullberg BJ. Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease. N Engl J Med. 2016 Mar 31;374(13):1209-20. doi: 10.1056/NEJMoa1505425. PubMed 27028911 ↗
  • van Middendorp H, Berende A, Vos FJ, Ter Hofstede HHM, Kullberg BJ, Evers AWM. Expectancies as predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease. Clin Rheumatol. 2021 Oct;40(10):4295-4308. doi: 10.1007/s10067-021-05760-1. Epub 2021 May 24. PubMed 34031759 ↗
  • Berende A, Agelink van Rentergem J, Evers AWM, Ter Hofstede HJM, Vos FJ, Kullberg BJ, Kessels RPC. Cognitive impairments in patients with persistent symptoms attributed to Lyme disease. BMC Infect Dis. 2019 Oct 7;19(1):833. doi: 10.1186/s12879-019-4452-y. PubMed 31590634 ↗
  • Berende A, Ter Hofstede HJM, Vos FJ, Vogelaar ML, van Middendorp H, Evers AWM, Kessels RPC, Kullberg BJ. Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis. Neurology. 2019 Mar 26;92(13):e1447-e1455. doi: 10.1212/WNL.0000000000007186. Epub 2019 Feb 22. PubMed 30796143 ↗
09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Sep 8, 2016, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT01207739
Lead sponsor
Radboud University Medical Center
Collaborators
Sint Maartenskliniek, ZonMw: The Netherlands Organisation for Health Research and Development
Responsible party
Sponsor
First posted
Sep 23, 2010
Start date
Sep 2010
Primary completion
Oct 2013
Completion
Oct 2014
Last update
Sep 8, 2016

Study contacts

Bart-Jan Kullberg, Prof., M.D.
principal investigator · Radboud University Medical Center

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Sep 2016. You cannot join it, but the record below documents what was studied.

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