OBJECTIVES: To assess the implementation of IDSA- and EUCALB-recommended first-line treatment of early Lyme Disease (LD) and progression to later-stage LD in the Northeastern United States (NE) compared to Florida, utilizing a large real-world dataset.

METHODS: Patients with medical histories consistent with early-stage LD diagnoses were identified within the TriNetX EHR and payer dataset (~190M patients). Patients were also required to have medical documentation in the 3 to 12 months prior and following LD diagnosis. Proportions of patients who received recommended LD first-line treatment (amoxicillin, doxycycline, or cefuroxime) in the NE and Florida were compared. To demonstrate efficacy of first-line treatment in preventing later-stage LD symptoms within the dataset, a propensity score analysis (1:1 greedy-nearest-neighbor matching) was run. A further cohort of all LD patients was defined and risk ratios of those who experienced symptoms consistent with later-stage LD in the two regions were compared.

RESULTS: 135,835 LD patients were identified across Florida and the NE, 92,542 experienced early-stage LD symptoms, and 43,293 experienced late-stage LD symptoms. Of early-stage LD patients, a significantly higher proportion of patients received recommended treatment in the NE (42.2%) than in Florida (21.8%) (p<0.0001). The risk of developing later-stage LD was significantly lower in patients that received recommended treatment (9.4%) compared to patients that did not (11.5%) (p<0.0001). Of all patients diagnosed with LD, patients had a significantly higher risk of being diagnosed with late-stage LD in the NE (30.9%) compared to Florida (46.2%) (p<0.0001).

CONCLUSIONS: LD is rapidly on the rise in Florida. This research indicates a significant deficit in recommended first-line treatment of LD and an increased proportion of late-stage diagnoses in Florida compared to the NE. These results signify that increased training/communication efforts may be warranted for Florida physicians to diagnose LD patients early in their disease and follow recommended first-line treatment.