Treatment of early seropositive rheumatoid arthritis: A two‐year, double‐blind comparison of minocycline and hydroxychloroquine

Objective To compare the efficacy of minocycline with that of a conventional disease‐modifying antirheumatic drug (DMARD), hydroxychloroquine, in patients with early seropositive rheumatoid arthritis (RA). Methods Sixty patients with seropositive RA of <1 year's duration who had not been pre...

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Bibliographic Details
Published in:	Arthritis and rheumatism Vol. 44; no. 10; pp. 2235 - 2241
Main Authors:	O'Dell, James R., Blakely, Kent W., Mallek, Jack A., Eckhoff, P. James, Leff, Rob D., Wees, Steven J., Sems, Kelly M., Fernandez, Ana M., Palmer, William R., Klassen, Lynell W., Paulsen, Gail A., Haire, Claire E., Moore, Gerald F.
Format:	Journal Article
Language:	English
Published:	New York John Wiley & Sons, Inc 01-10-2001 Wiley
Subjects:	Adult Aged Anti-Bacterial Agents - administration & dosage Antirheumatic Agents - administration & dosage Arthritis, Rheumatoid - drug therapy Arthritis, Rheumatoid - immunology Arthritis, Rheumatoid - physiopathology Biological and medical sciences Bones, joints and connective tissue. Antiinflammatory agents Double-Blind Method Female Humans Hydroxychloroquine - administration & dosage Male Medical sciences Middle Aged Minocycline - administration & dosage Pharmacology. Drug treatments Serologic Tests Treatment Outcome Human Immunopathology Treatment efficiency Tetracycline derivatives Diseases of the osteoarticular system Autoimmune disease Inflammatory joint disease Chemotherapy Chronic Hydroxychloroquine Treatment Rheumatoid arthritis Minocycline Antirheumatic agent Immunosuppressive agent Comparative study
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Summary:	Objective To compare the efficacy of minocycline with that of a conventional disease‐modifying antirheumatic drug (DMARD), hydroxychloroquine, in patients with early seropositive rheumatoid arthritis (RA). Methods Sixty patients with seropositive RA of <1 year's duration who had not been previously treated with DMARDs were randomized to receive minocycline, 100 mg twice per day, or hydroxychloroquine, 200 mg twice per day, in a 2‐year, double‐blind protocol. All patients also received low‐dose prednisone. The primary end points of the study were 1) the percentage of patients with an American College of Rheumatology (ACR) 50% improvement (ACR50) response at 2 years, and 2) the dosage of prednisone at 2 years. Results Minocycline‐treated patients were more likely to achieve an ACR50 response at 2 years compared with hydroxychloroquine‐treated patients (60% compared with 33%, respectively; P = 0.04). Minocycline‐treated patients were also receiving less prednisone at 2 years compared with the hydroxychloroquine group (mean 0.81 mg/day compared with 3.21 mg/day, respectively; P < 0.01). In addition, patients treated with minocycline were more likely to have been completely tapered off prednisone (P = 0.03). Trends favoring the minocycline treatment group were seen when outcomes were assessed according to components of the ACR core criteria set, with the differences reaching statistical significance for patient's global assessment of disease activity (P = 0.004). Conclusion Minocycline is an effective DMARD in patients with early seropositive RA. Patients treated with minocycline were more likely to achieve an ACR50 response and did so while receiving less prednisone. In addition, minocycline‐treated patients were more likely to have discontinued treatment with prednisone at 2 years.
ISSN:	0004-3591 1529-0131
DOI:	10.1002/1529-0131(200110)44:10<2235::AID-ART385>3.0.CO;2-A