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

[Guest guest]

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