Effects of Doxycycline on progression of Osteoarthritis
Effects of doxycycline on progression of osteoarthritis: results of a randomized, placebo-controlled, double-blind trial.KD Brandt, SA Mazzuca, BP Katz, KA Lane, KA Buckwalter, DE Yocum, F Wolfe, TJ Schnitzer, LW Moreland, S Manzi, JD Bradley, L Sharma, CV Oddis, ST Hugenberg, LW HeckArthritis Rheum 2005 7;52(7):2015-25
Our current management of osteoarthritis (OA) lacks pharmaceutical agents that are disease modifying (DMOADs). The search for agents that slow or halt radiographic progression has met with very limited success to date. Dr.Brandt and colleagues describe the results of a multicenter, randomized, placebo-controlled, double-blind trial of doxycycline in 435 obese women with moderately advanced OA in one knee (joint space narrowing {JSN} in the medial tibiofemoral compartment) and no disease in the contralateral knee. The patients were treated with doxycycline 100 mg twice daily or placebo for 30 months. The rationale for the use of doxycycline in OA was based on studies demonstrating doxycycline’s inhibition of collagenase enzymes. The involved knees showed 40% and 33% less JSN at 16 and 30 months compared to the placebo group. Doxycycline did not reduce joint pain despite slowing radiographic progression and had no apparent effect on pain or joint space narrowing in the contralateral knee. Side effects were unusual and included sun sensitivity, abdominal symptoms and vaginitis in the doxycycline group and less urinary tract and upper respiratory infections also in the doxycycline patients. An accompanying editorial in the same issue of Arthritis and Rheumatism by Dr. Dieppe suggests many unanswered questions remain :(1) Why the lack of effect on the contralateral knee? (2) Why the disconnect between radiographic slowing and pain relief? (3) Will further studies show similar results in men and in other sites of OA involvement? (4) Will long standing disease respond in a similar fashion? (5) Will doxycycline prove to be safe if used long term in older patients. More studies are needed to answer these and other questions regarding doxycycline and other potential DMOADs.
Arthur L. Weaver MD, MS
Our current management of osteoarthritis (OA) lacks pharmaceutical agents that are disease modifying (DMOADs). The search for agents that slow or halt radiographic progression has met with very limited success to date. Dr.Brandt and colleagues describe the results of a multicenter, randomized, placebo-controlled, double-blind trial of doxycycline in 435 obese women with moderately advanced OA in one knee (joint space narrowing {JSN} in the medial tibiofemoral compartment) and no disease in the contralateral knee. The patients were treated with doxycycline 100 mg twice daily or placebo for 30 months. The rationale for the use of doxycycline in OA was based on studies demonstrating doxycycline’s inhibition of collagenase enzymes. The involved knees showed 40% and 33% less JSN at 16 and 30 months compared to the placebo group. Doxycycline did not reduce joint pain despite slowing radiographic progression and had no apparent effect on pain or joint space narrowing in the contralateral knee. Side effects were unusual and included sun sensitivity, abdominal symptoms and vaginitis in the doxycycline group and less urinary tract and upper respiratory infections also in the doxycycline patients. An accompanying editorial in the same issue of Arthritis and Rheumatism by Dr. Dieppe suggests many unanswered questions remain :(1) Why the lack of effect on the contralateral knee? (2) Why the disconnect between radiographic slowing and pain relief? (3) Will further studies show similar results in men and in other sites of OA involvement? (4) Will long standing disease respond in a similar fashion? (5) Will doxycycline prove to be safe if used long term in older patients. More studies are needed to answer these and other questions regarding doxycycline and other potential DMOADs.
Arthur L. Weaver MD, MS
posted by Ricardo Pocurull at 8:57 AM
0 Comments:
Post a Comment
<< Home