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.
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.
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.
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 12 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%).
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 %||93.68||89.72||0.005|
|Lifetime DMARD||2.90 (1.83)||2.13 (1.54)||<0.001|
|Lifetime DMARD & Biologics||3.30 (2.10)||2.52 (1.81)||<0.001|
|SF-36 PCS (0100)||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