Repurposing Disulfiram in the Treatment of Lyme Disease and Babesiosis: Retrospective Review of First 3 Years’ Experience in One Medical Practice

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“Repurposing” Disulfiram in the Treatment of Lyme Disease and Babesiosis: Retrospective Review of First 3 Years’ Experience in One Medical Practice

Jiachen Gao 1, Zhaodi Gong 2, Dawn Montesano 3, Erica Glazer 3 and Kenneth Liegner 3,4,5,*

* Correspondence: kbliegnermd@optonline.net

Received: 7 August 2020; Accepted: 3 December 2020; Published: 4 December 2020

College of Arts and Sciences, Boston University, 725 Commonwealth Avenue, Boston, MA 02215, USA; gaojiachen10@gmail.com
CT Integrated Pain Consultants, LLC, 60 Katona Drive, Suite 25, Fairfield, CT 06824, USA; abatapain@gmail.com

P.C. Lyme Borreliosis & Related Disorders, 592 Route 22, Suite 1B, Pawling, NY 12564, USA; dawnmontesano83@gmail.com (D.M.); eglazer5@optimum.net (E.G.)
Northwell System, Northern Westchester Hospital Center, Mount Kisco, NY 10549, USA Nuvance Health System, Sharon Hospital, Sharon, CT 06069, USA

Abstract: A total of 71 patients with Lyme disease were identified for analysis in whom treatment with disulfiram was initiated between 15 March 2017 and 15 March 2020. Four patients were lost to follow-up, leaving 67 evaluable patients. Our retrospective review found patients to fall into a “high-dose” group (4 mg/kg/day) and a “low-dose” group (<4 mg/kg/day). In total, 62 of 67 (92.5%) patients treated with disulfiram were able to endorse a net benefit of the treatment with regard to their symptoms. Moreover, 12 of 33 (36.4%) 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. The most common adverse reactions from disulfiram treatment in the high-dose group were fatigue (66.7%), psychiatric symptoms (48.5%), peripheral neuropathy (27.3%), and mild to moderate elevation of liver enzymes (15.2%). We observed that although patients on high dose experienced a higher risk for adverse reactions than those on a low dose, high-dos patients were significantly more likely to achieve enduring remission.

Keywords: disulfiram; chronic Lyme disease; post-treatment Lyme disease syndrome (PTLDS); persistent infection; antibiotic treatment failure; relapsing infection; babesiosis; bartonellosis