Persistent Lyme Empiric Antibiotic Study Europe (PLEASE)

This study is ongoing, but not recruiting participants.
Sint Maartenskliniek
ZonMw: The Netherlands Organisation for Health Research and Development
Information provided by (Responsible Party):
Radboud University Identifier:
First received: September 22, 2010
Last updated: July 12, 2013
Last verified: July 2013

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.

Condition Intervention Phase
Lyme Disease
Borrelia Infection
Drug: Doxycycline
Drug: Clarithromycin and hydroxychloroquine
Drug: Placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Persistent Lyme Empiric Antibiotic Study Europe. A Prospective, Randomised Study Comparing Two Prolonged Oral Antibiotic Strategies After Initial Intravenous Ceftriaxone Therapy for Patients With Symptoms of Proven or Possible Persistent Lyme Disease

Resource links provided by NLM:

Further study details as provided by Radboud University:

Primary Outcome Measures:
  • Global score 36-item Short-form General Health Survey (SF 36) [ Time Frame: Week 14 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Subscales 36-item Short-form General Health Survey (SF 36) [ Time Frame: weeks 0, 14, 26 and 40 ] [ Designated as safety issue: No ]
  • Actometer recording during 14 days (objective physical activity) [ Time Frame: weeks 0, 14 and 40 ] [ Designated as safety issue: No ]
  • Measurements of neuropsychological impairment [ Time Frame: weeks 0, 14, 26 and 40 ] [ Designated as safety issue: No ]
  • Economic evaluation: Questionaire EQ-5D, health consumption and productivity of labour [ Time Frame: weeks 0, 14, 26 and 40 ] [ Designated as safety issue: No ]
  • Fatigue subscale of Checklist Individual Strength (CIS) [ Time Frame: weeks 0, 14, 26, and 40 ] [ Designated as safety issue: No ]

Estimated Enrollment: 270
Study Start Date: September 2010
Estimated Study Completion Date: February 2014
Estimated Primary Completion Date: October 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Doxycycline Drug: Doxycycline
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
Other Names:
  • Doxycycline disper
  • CASnr 564-25-0 (doxycycline); 17086-28-1 (doxycycline monohydraat)
Active Comparator: Clarithromycin and hydroxychloroquine Drug: Clarithromycin 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
Other Names:
  • Clarithromycine Mylan, RVG 32619
  • CASnr 81103-11-9
  • Hydroxychloroquine; Plaquenil, RVG 00853
  • CASnr 118-42-3 (hydroxychloroquine); 737-36-4 (hydroxychloroquine sulfate)
Placebo Comparator: Placebo Drug: Placebo
After open-label i.v. ceftriaxone 2000 mg qd via a peripheral i.v. catheter: 12 weeks' course of double placebo b.i.d.


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
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:

  • 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).
  Contacts and Locations
Please refer to this study by its identifier: NCT01207739

Radboud University Nijmegen Medical Centre
Nijmegen, Netherlands, 6500 HB
Sint Maartenskliniek
Nijmegen, Netherlands, 6522 JV
Sponsors and Collaborators
Radboud University
Sint Maartenskliniek
ZonMw: The Netherlands Organisation for Health Research and Development
Principal Investigator: Bart-Jan Kullberg, Prof., M.D. Radboud University
  More Information

No publications provided

Responsible Party: Radboud University Identifier: NCT01207739     History of Changes
Other Study ID Numbers: PLEASE, NL-27344.091.09, 2009-010939-40
Study First Received: September 22, 2010
Last Updated: July 12, 2013
Health Authority: Netherlands: Medical Ethics Review Committee (METC)
Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)

Keywords provided by Radboud University:
Prolonged antibiotic treatment in Lyme disease

Additional relevant MeSH terms:
Lyme Disease
Borrelia Infections
Gram-Negative Bacterial Infections
Bacterial Infections
Tick-Borne Diseases
Spirochaetales Infections
Anti-Bacterial Agents
Doxycycline hyclate
Antibiotics, Antitubercular
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Antitubercular Agents
Antiprotozoal Agents
Antiparasitic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antirheumatic Agents
Protein Synthesis Inhibitors processed this record on April 17, 2014