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 convention al disease-modifying antirheumatic drug (DMARD), hydroxychloroquine, in pat ients 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 minocycl ine, 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 predni sone. The primary end points of the study were 1) the percentage of patient s with an American College of Rheumatology (ACR) 50% improvement (ACR50) re sponse 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 we re also receiving less prednisone at 2 years compared with the hydroxychlor oquine 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 accordin g to components of the ACR core criteria set, with the differences reaching statistical significance for patient's global assessment of disease activi ty (P = 0.004). Conclusion. Minocycline is an effective DMARD in patients with early seropo sitive RA. Patients treated with minocycline were more likely to achieve an ACR50 response and did so while receiving less prednisone. In addition, mi nocycline-treated patients were more likely to have discontinued treatment with prednisone at 2 years.