title: Radiographic results from the Minocycline in Rheumatoid Arthritis (MIRA) Trial.
abstract: OBJECTIVE
  To assess radiographically determined disease progression in patients in the Minocycline in Rheumatoid Arthritis (MIRA) Trial.
  
  
  METHODS
  A double blind, randomized, multicenter, 48 week trial of oral minocycline (200 mg/day) or placebo in 6 clinical centers in the United States. Patients include 219 adults with active RA previously receiving limited treatment with disease modifying drugs. Posteroanterior films of the hands from baseline and final visits, blinded for sequence, were read for erosions and joint space narrowing by trained observers. Outcomes included rate of disease progression (change/month) and percentage of patients with progression from baseline, newly involved joints, and newly erosive disease.
  
  
  RESULTS
  Using intent-to-treat analyses, progression rates for erosions (0.11 +/- 0.42 minocycline, 0.17 +/- 0.41 placebo; p = 0.47) and joint space narrowing (0.16 +/- 0.55 minocycline and 0.23 +/- 0.71 placebo; p = 0.14) were similar. (Power 43% to detect a 50% difference.) Newly erosive joints occurred more frequently in the placebo group (44 vs 32%; p = 0.08), not a statistically significant difference.
  
  
  CONCLUSIONS
  Radiographic measurement of disease progression using 4 measures failed to show a significant difference between minocycline and placebo treatment, although for all methods there was a trend toward treatment benefit, consistent with reported clinical results. A one year trial duration, high measurement variability, and slow rate of radiographic progression in this cohort may explain the low power to detect a treatment effect. The measurement that denoted "newly involved" joints was most sensitive in detecting change. In future trials longer term assessment (minimum 2 years) of radiographic changes and further comparison of measures of disease progression are warranted.
authors.affiliation: Henry Ford Hospital, Detroit, MI 48202, USA.
authors.forename: G B
authors.initials: GB
authors.lastname: Bluhm
authors.forename: J T
authors.initials: JT
authors.lastname: Sharp
authors.forename: B C
authors.initials: BC
authors.lastname: Tilley
authors.forename: G S
authors.initials: GS
authors.lastname: Alarcon
authors.forename: S M
authors.initials: SM
authors.lastname: Cooper
authors.forename: S R
authors.initials: SR
authors.lastname: Pillemer
authors.forename: D O
authors.initials: DO
authors.lastname: Clegg
authors.forename: S P
authors.initials: SP
authors.lastname: Heyse
authors.forename: D E
authors.initials: DE
authors.lastname: Trentham
authors.forename: R
authors.initials: R
authors.lastname: Neuner
authors.forename: D A
authors.initials: DA
authors.lastname: Kaplan
authors.forename: J C
authors.initials: JC
authors.lastname: Leisen
authors.forename: L
authors.initials: L
authors.lastname: Buckley
authors.forename: H
authors.initials: H
authors.lastname: Duncan
authors.forename: M
authors.initials: M
authors.lastname: Tuttleman
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.forename: S E
authors.initials: SE
authors.lastname: Fowler
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage*; D010919:Placebos; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010919:Placebos; D008911:Minocycline