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 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).


CONCLUSIONS
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.
O'Dell
J R
JR
University of Nebraska Medical Center, Omaha 68198-3025, USA. jrodell@unmc.edu
Blakely
K W
KW
Mallek
J A
JA
Eckhoff
P J
PJ
Leff
R D
RD
Wees
S J
SJ
Sems
K M
KM
Fernandez
A M
AM
Palmer
W R
WR
Klassen
L W
LW
Paulsen
G A
GA
Haire
C E
CE
Moore
G F
GF
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage*; D012698:Serologic Tests; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D008911:Minocycline