Association between statin use and clinical course, microbiologic characteristics, and long-term outcome of early Lyme borreliosis. A post hoc analysis of prospective clinical trials of adult patients with erythema migrans

Abstract

Background Statins were shown to inhibit borrelial growth in vitro and promote clearance of spirochetes in a murine model of Lyme borreliosis (LB). We investigated the impact of statin use in patients with early LB. Methods In this post-hoc analysis, the association between statin use and clinical and microbiologic characteristics was investigated in 1520 adult patients with early LB manifesting as erythema migrans (EM), enrolled prospectively in several clinical trials between June 2006 and October 2019 at a single-center university hospital. Patients were assessed at enrollment and followed for 12 months. Results Statin users were older than patients not using statins, but statin use was not associated with Borrelia seropositivity rate, Borrelia skin culture positivity rate, or disease severity as assessed by erythema size or the presence of LB-associated symptoms. The time to resolution of EM was comparable in both groups. The odds for incomplete recovery decreased with time from enrollment, were higher in women, in patients with multiple EM, and in those reporting LB-associated symptoms at enrollment, but were unaffected by statin use. Conclusion Statin use was not associated with clinical and microbiologic characteristics or long-term outcome in early LB.

Current Treatment Approaches to Eliminate <em>Borrelia burgdorferi </em>and Potential Strategies to Alleviate Persistent Lyme Disease Symptoms

“…B. burgdorferi genome encodes a functional 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGR EC 1.1.1.88) which contributes to a vital component necessary for peptidoglycan and cell wall biogenesis [135]. Commercially available statins, such as simvastatin and lovastatin affected in vitro growth of B. burgdorferi MSK5 strain by inhibiting HMGR [136] and reduced the burden of spirochetes in mouse models. Moreover, treating infected mice with lovastatin notably upregulates several cytokines associated with the TH2 immune response, including IL-4, IL-5, IL-9, IL-10, and IL-13 [135,137] and likely decreased bacterial burden in treated mice by either direct interference with spirochetal growth, modulation of the immune response, limitation of cholesterol availability to the spirochetes, or a combination of these mechanisms.…”