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Background Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be noninferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB. Methods Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were (1) production of Borrelia burgdorferi– specific antibodies in cerebrospinal fluid (CSF) or serum; (2) B. burgdorferi DNA in the CSF; or (3) an erythema migrans during the past 3 months. Participants were randomized in a 1:1 ratio to receive either oral doxycycline 100 mg twice daily for 4 weeks, or intravenous ceftriaxone 2 g daily for 3 weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months. Results Between 14 September 2012 and 28 December 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n = 104) or ceftriaxone (n = 106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was −3.9 in the doxycycline group and −3.8 in the ceftriaxone group (mean difference, 0.17 [95% confidence interval, −.59 to.92], which is within the prespecified equivalence margins of −1 to 1 units). Participants in both groups improved equally. Conclusions Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB. Clinical Trials Registration NCT01635530 and EudraCT 2012-000313-37. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the positive predictive value (PPV) of 17 myositis antibodies for having a diagnosis of myositis and other myositis-spectrum conditions (interstitial lung disease (ILD), connective tissue diseases (CTD), malignancy) and evaluated the impact of semiquantitative classification and antibody overlap on the PPVs., Materials and Methods: We retrospectively identified 1068 individuals ≥18 years who tested positive for ≥1 antibody in the EUROLINE myositis line blot assay or positive for anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) in an ELISA-based test between 2015 and 2020 in 15 out of the 20 hospital districts in Finland. We extracted clinical diagnoses from the Care Register for Health Care between January 2013 and June 2022., Results: The PPV for a myositis diagnosis (ever during data collection) was highest for anti-HMGCR antibodies (94%), followed by anti-MDA5, anti-Jo-1 and anti-TIF1-γ (49-54%). Regarding other myositis antibodies, 18-42% of cases had myositis. Anti-synthetase antibodies, anti-MDA5, anti-PM-Scl100, anti-SAE1 and anti-Ro52 had a PPV for ILD of 25-47%. A PPV for CTD was highest for anti-Ro52 (57%). The PPV for malignancy was highest for anti-TIF1-γ (38%), followed by anti-PL-7 (32%). Stronger antibody band intensity was associated with higher PPVs for myositis and CTD but not for ILD or malignancies. Simultaneous positivity for ≥2 antibodies compared with single antibody was associated with higher PPVs for myositis, CTD and ILD., Conclusion: The PPV of myositis antibodies for diagnoses of myositis or other myositis spectrum diseases vary considerably between individual autoantibodies. Higher PPVs can be expected with stronger band intensities and with the presence of ≥2 overlapping myositis antibodies., Competing Interests: Competing interests: AMK has received speaker fees from Boehringer-Ingelheim, AbbVie and Sanofi; has participated in the advisory boards of Pfizer and Boehringer-Ingelheim; and has received congress sponsorship from AbbVie and Johnson & Johnson, which are all unrelated to this work. AH has received a speaker fee from UCB Pharma and consulting fees from Labquality Oy, unrelated to this work. APi, JB, APa: none declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)