Oh wow, reading those case studies is like looking in a mirror. Those patients took a million different meds, got better, got worse again, got better... I can relate a lot. Makes me wonder if I should try dapsone too. I'm not sure that's possible in my country though.
Anyway, interesting part from the text:
HDDCT = short-term high dose pulsed dapsone combination therapy
DDDCT = double dose dapsone combination therapy
DSF = Disfuliram
Wall of text said...
Prior culture studies using dapsone alone and in combination with other intracellular antibiotics (tetracyclines, rifampin, azithromycin) had shown that dapsone as a single drug and in combination with doxycycline +/− rifampin as well as doxycycline + rifampin + azithromycin had the most significant effect in reducing the mass, viability, and protective mucopolysaccharide (MPS) layers of B. burgdorferi biofilm [34]. Borrelia persister bacteria in biofilms have been determined to be a significant cause of inflammation [27] that are known to be a major factor in driving chronic symptomatology in Lyme disease patients with CLD/PTLDS [82], and higher doses of dapsone in culture (50 μM vs. 10 μM concentrations) were found to be more effective than lower doses in reducing the mass, viability, and MPS of Borrelia biofilm [34]. This might explain, at least in part, dapsone’s clinical efficacy that was seen in recent DDSCT trials and in our present trial of HDDCT. A similar finding with another ‘persister’ drug for Lyme disease, disulfiram, was found to be more effective at keeping patients in remission if it was taken at higher doses [33]. In that study, 36.4% of patients who completed one or two courses of “high-dose” therapy enjoyed an “enduring remission”, defined as remaining clinically well for ≥6-months without further anti-infective treatment, and high-dose patients were significantly more likely to achieve enduring remission [33]. We found similar results in our study. DDDCT at 100 mg PO BID was more effective than single dose dapsone (100 mg), and HDDCT (200 mg PO BID × 4 days) with one to three courses being more effective than DDDCT (200 mg PO BID × 28 days) in helping to keep certain patients in long-term remission as long as the majority had already done one or more courses of DDDCT and all abnormal MSIDS variables were addressed. One patient who failed DDDCT and was on DSF intermittently for up to 18-months, at doses ranging from 250 mg per day to 250 mg PO BID, improved her underlying symptoms of fatigue, headaches, and mood disorder. She felt DSF was more effective for her symptoms of CLD/PTLDS (EM+) but continued to relapse off DSF. She took one course of HDDCT after coming off DSF and went into remission for 3-months or longer. Combining two persister drugs such as dapsone (DDS) or DSF, or rotating them, was effective in this patient who did not have an adequate response to one prior course of DDSCT. Of the eight patients who went into remission, 5/8 (62.5%) took DSF in varying dosages either before or during HDDCT, and 4/8 (50%) had prior exposure to Bartonella. Future studies should evaluate the efficacy of combining persister drugs to improve long-term remission for CLD/PTLDS and associated infections.
...
Our study points to the possibility that it is not necessarily the length of time on persister drugs such as dapsone, but rather the dose that may play a critical role in addressing resistant biofilm forms of Borrelia burgdorferi.
Post Edited (Vimzor) : 7/10/2022 9:29:16 PM (GMT-7)