Single-Blind Randomized Trial of Combination Antibiotic Therapy in RA

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Single-Blind Randomized Trial of Combination Antibiotic Therapy in

Rheumatoid Arthritis

http://www.jrheum.com/abstracts/abstracts06/224.html

LUKE L. GOMPELS, ANGELA SMITH, PETER J. CHARLES, WENDY ROGERS, JOANNE

SOON-SHIONG, ADAM MITCHELL, CAROLINE DORÉ, PETER W. TAYLOR, and CHARLES G.

MACKWORTH-YOUNG

ABSTRACT.

Objective. To determine the potential clinical efficacy of combination

antibiotic therapy in treating rheumatoid arthritis (RA).

Methods. Twenty-one patients with active RA despite second-line treatment

were randomized to receive either combination antibiotic therapy (treatment

group, n = 11) or no additional therapy (control group, n = 10). Antibiotic

therapy was given for 12 months and comprised oral tetracycline 250 mg twice

daily, 3 times per week, and intravenous clindamycin infused on 5

consecutive days (300, 300, 600, 600, and 900 mg) followed by weekly

infusions of 900 mg for 3 weeks and then fortnightly infusions for the

remainder of the 12 months. The primary outcome measure was the American

College of Rheumatology 20% (ACR20) response at the end of the initial

treatment period of 12 months.

Results. Five patients in the treatment group (45%) achieved an ACR20

response at 1 year compared to none in the control group (p = 0.04). Eight

patients in the treatment group and 1 in the control group had a greater

than 20% improvement in tender joint count (p = 0.008). There were also

significant differences between the groups in physician and patient global

assessments. Nine patients in the treatment group completed the 6 months'

followup; of these, 3 sustained the ACR20 response.

Conclusion. Combined antibiotic therapy with intravenous clindamycin and

oral tetracycline may be useful in the management of active RA. A

double-blind, placebo-controlled trial of therapy is justified. (J Rheumatol

2006;33:224-7)

From the Kennedy Institute of Rheumatology; Charing Cross Hospital; and

Other Disease Group Statistics, MRC Clinical Trials Unit, London, England.

Supported by a grant from the Peacock Charitable Trust. Dr. Doré is funded

by the Arthritis Research Campaign.

L.L. Gompels, MRCP, Charing Cross Hospital; A. , BSc, Kennedy Institute

of Rheumatology; P.J. , CSci FIBMS; W. , BSc; J. Soon-Shiong,

MSc; A. , FRCR, Charing Cross Hospital; C. Doré, BSc, Other Disease

Group Statistics; P.W. , PhD, Charing Cross Hospital; C.G.

Mackworth-Young, MD, Kennedy Institute of Rheumatology and Charing Cross

Hospital.

Address reprint requests to Dr. C.G. Mackworth-Young, Charing Cross

Hospital, Fulham Palace Road, London, W6 8RF, England. E-mail:

c.mackworth-young@...