Re: INFO - Why aren't more people taking minocycline for RA?

August 30, 2005

--- <Matsumura_Clan@...> wrote:

> Arthritis News Magazine

> Ask the Experts

> 2001

>

> Why aren't more people taking minocycline (Minocin)

> for rheumatoid

> arthritis?

>

> I'm taking minocycline and find it beneficial. Why

> isn't it utilized more?

> It's much cheaper than Enbrel.

>

> The Pharmacist Answers

>

> Minocycline is a tetracycline antibiotic that was

> marketed in 1972 for the

> treatment of chest, bladder and other infections. In

> recent years it has

> been more commonly used, at a lower dosage, for the

> treatment of acne in

> teenagers.

>

> To review the status of minocycline in the treatment

> of rheumatoid arthritis

> (RA), we need to look at how medications are

> selected for use in RA. A

> medication is chosen according to three criteria:

> its effectiveness in mild,

> moderate or severe RA; its historical experience;

> and its side-effect

> profile.

>

> 1) Effectiveness. In research to date, minocycline

> appears to be of benefit

> only in early or mild RA, as shown in two open

> studies and three

> double-blind, placebo-based trials. However, these

> trials did not compare

> minocycline to the two standard medications used to

> treat mild or early RA;

> namely, hydroxychloroquine (Plaquenil) and

> sulfasalazine

> (Alti-Sulfasalazine). These studies only compared

> minocycline with a placebo

> (sugar tablet). The lack of direct-comparison

> research places minocycline in

> a position of possible use if intolerance, allergy

> or lack of benefit occurs

> with the standard medications.

>

> It is important to note that minocycline would not

> be available for

> treatment of early or mild RA if it were not already

> on the market as an

> antibiotic. Minocycline lacks the comparative

> research data required of new

> agents in 2001 and the experiential data of the

> older agents. Furthermore,

> Wyeth-Ayerst, minocycline's original manufacturer,

> is not researching the

> impact of the drug on RA and is not seeking official

> approval for

> minocycline in the treatment of RA.

>

> 2) Historical experience. Rheumatologists have a

> long history of experience

> in RA treatment with both hydroxychloroquine and

> sulfasalazine, but little

> experience with minocycline. Of interest is that

> hydroxychloroquine and

> sulfasalazine are anti-infective in nature. However,

> they are not standard

> antibiotics, as is minocycline. No infection role

> has been proven in RA and

> indeed, it is felt that all three of these

> medications exert their effect in

> RA through anti-inflammatory mechanisms, not as

> anti-infectives.

>

> 3) Side-effect profile. At the full antibiotic

> dosage recommended for use in

> RA (100 mg twice daily), minocycline has several

> side effects of concern,

> including dizziness and changes to skin

> pigmentation. As well, there are all

> the usual concerns with antibiotic use - increased

> bacterial resistance,

> stomach distress and the potential for fungal

> infections. Also, minocycline

> may, very rarely, cause an autoimmune process of its

> own, presenting as

> joint pain. In patients with RA, it can be a

> challenge to differentiate the

> joint pain of arthritis from possible

> minocycline-induced joint pain. The

> telling difference is that minocycline-induced

> autoimmune joint pain

> disappears when the drug is stopped.

>

> With respect to your question about etanercept

> (Enbrel), minocycline would

> not be prescribed in place of it. Enbrel is only

> approved for use in severe

> or resistant RA, not early or mild RA.

>

> I hope this is helpful. Thanks for the interesting

> and challenging question!

>

http://www.arthritis.ca/programs%20and%20resources/news%20magazine/2001/ask%20th\

e%20experts2/default.asp?s=1

>

> Not an MD

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

Does anyone know of any current studies with

minocycline? I just recently started taking

minocycline-after some online research-in addition to

MTX 10 mgs weekly. (I had to ask for it. It was never

mentioned by my GP and either of 2 rheumatologists

that I have seen.) Everything I read sounded like

some improvement was noted in over 50% of patients in

what limited studies are available today. I would

think that something that holds some hope of helping

improve quality of life and is much less expensive

than some of the newer drugs would warrant some

" good " controlled studies. Maybe I haven't looked in

the right places but sounds like more research is

needed.

__________________________________________________

August 30, 2005