2000: minocycline in rheumatoid arthritis. No adverse effects were reported in this study.

1: Drug Saf. 2000 May;22(5):405-14. Related Articles, Links


Benefits and risks of minocycline in rheumatoid arthritis.

Langevitz P, Livneh A, Bank I, Pras M.

Rheumatic Disease Unit, Chaim Sheba Medical Center, Tel Hashomer,
Israel.

Rheumatoid arthritis is a chronic inflammatory disease affecting about
1% of the adult population. The pathophysiology of rheumatoid arthritis
remains incompletely understood. An infectious aetiology of the disease
has long been postulated, but not proved. Despite insufficient evidence
for the infectious nature of this disorder, several antibacterials,
such as sulfa compounds, tetracyclines and rifampicin, have been
investigated in the treatment of rheumatoid arthritis. In the last few
years, minocycline, a semi-synthetic derivative of tetracycline, has
been extensively studied as a therapeutic agent for rheumatoid
arthritis. The antirheumatic effect of minocycline can be related to
its immunomodulatory and anti-inflammatory, rather than to its
antibacterial properties. Its efficacy in rheumatoid arthritis has been
reported in 2 open trials and in 3 double-blind controlled studies. The
first 2 double-blind studies, 1 in The Netherlands and 1 in the US,
were performed in patients with advanced disease. Both studies showed a
modest, but statistically significant improvement in the clinical
parameters of disease activity and in the erythrocyte sedimentation
rate in the minocycline-treated patients. The US study also reported
that patients in the minocycline group developed fewer erosions than
those in the placebo group. This finding supports the role of
minocycline as a disease modifying agent. The common adverse effects of
minocycline reported in these 2 studies included gastrointestinal
adverse effects, dizziness, rash and headaches. Less common adverse
effects were intracranial hypertension, pneumonitis, persistent skin
and mucosal hyperpigmentation, lupus-like syndrome and acute hepatic
injury. The third double-blind study enrolled only seropositive
rheumatoid arthritis patients with early disease (less than 1 year
duration), and showed very encouraging results of significant
improvement in the disease activity parameters in the minocycline
treated group of patients. The same authors later reported that about
half of these patients were in or near remission after 3 years of
follow up. No adverse effects were reported in this study. Summarising
the data of these 3 double-blind studies, we may conclude that
minocycline may be beneficial in patients with rheumatoid arthritis,
especially when given early in the disease course or in patients with a
mild disease.

Publication Types:
Review

PMID: 10830256 [PubMed - indexed for MEDLINE]

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