Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Minocycline and Doxycycline Therapy in Community Patients with Rheumatoid Arthritis (RA): Incidence, Patient-Level Determinants of Use and Side Effects.

Smith2,  Christopher J., Sayles2,  Harlan R., Mikuls1,  Ted R., Michaud1,  Kaleb D.

Univ of Nebraska Med Ctr, Omaha, NE
University of Nebraska Med Ctr, Omaha, NE

Background:

Minocycline (MC) and doxycycline (DC) are safe and moderately effective disease-modifying antirheumatic drugs (DMARDs) in the treatment of early, DMARD-naive RA. Little is known about how these medications are used outside the context of clinical trials. We characterize the use of MC and DC in a large community of RA patients by examining associated prescribing patterns, patient-level determinants of use, and the frequency and severity of patient-reported side effects.

Methods:

We studied 15,716 patients with RA observed between 1998 and 2009 while participating in a long-term US observational study. Patients were categorized by their use of MC/DC. Patient-reported side effects and their consequences were also evaluated.

Results:

MC and/or DC were used 1,407 (9%) patients during their disease course with 480 (3.1%) incident users. Patients were seen by 1,067 rheumatologists, of which 196 (18.4%) prescribed MC/DC with an interquartile range of 1–2 patients per physician. Significant differences between MC/DC users and non-users are shown.

In multivariable Cox regression, initiation of MC/DC was significantly associated with an increase in disease activity, comorbidity, previous number of non-biologic DMARDs, and calendar year, and associated with a decrease in previous number of biologic DMARDs and use of MTX, leflunomide or azathioprine. Side effects were reported by 17.8% of MC users and 11.8% of DC users. About 40% of those reporting side effects discontinued the medication. Skin complaints accounted for 54% of MC patient-reported side-effects. The most-commonly effected organ systems for DC were gastrointestinal (35.4%) and skin (33.7%). Dizziness was reported equally by MC (9.5%) and DC (8.2%) users. The majority of side effects were classified as mild or moderate for MC (70.0%) and DC (76.4%).

Conclusion:

Rheumatologists have not embraced MC and DC as primary treatment options for RA and reserve their use primarily in patients with long-standing disease refractory to other agents. These drugs are generally well-tolerated with skin complaints, nausea, and dizziness being the most common patient-reported side effects.

Table. Sociodemographic and disease characteristics of MC/DC users and non-users

 Initiated MC and/or DC (n = 480)Never Used MC or DC (n = 14,309)p-value
RA Duration (years)14.77 (10.92)13.70 (11.05)0.036
Age (years)58.35 (11.60)59.76 (13.28)0.021
Caucasian, Non-Hispanic %93.6889.720.005
Lifetime DMARD2.90 (1.83)2.13 (1.54)<0.001
Lifetime DMARD & Biologics3.30 (2.10)2.52 (1.81)<0.001
Prednisone %40.0835.340.033
SF-36 PCS (0–100)35.03 (11.17)36.39 (11.09)0.008

To cite this abstract, please use the following information:
Smith, Christopher J., Sayles, Harlan R., Mikuls, Ted R., Michaud, Kaleb D.; Minocycline and Doxycycline Therapy in Community Patients with Rheumatoid Arthritis (RA): Incidence, Patient-Level Determinants of Use and Side Effects. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :318
DOI: 10.1002/art.28087

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