Hotline

Minocycline Treatment for Scleroderma

Scleroderma represents a disease continuum characterized by tissue fibrosis involving skin and potentially internal organ involvement. Our current understanding of scleroderma suggests several different biologic processes prominent in the disease, including autoimmunity, fibrosis and chronic non-inflammatory small-vessel vasculopathy. At this time, there is no single drug that has been proven useful for all of these abnormalities in a rigorous controlled trial.

Recently, David Trentham, MD, (Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts) presented at the 6th Biennial Congress of the International Society for Rheumatic Therapies the results of a small open study in which minocycline was used for the treatment of scleroderma. Eleven patients with a diagnosis of scleroderma for three years or less were enrolled. No information about the subjects' internal organ involvement was obtained. All subjects were treated with minocycline at 100 mg twice a day for one year. Six of the 11 patients completed the one-year study and four of the six had complete remissions described as skin scores of zero. No information regarding lung, kidney or cardiac function was obtained on these patients. Five subjects did not complete the study of whom two developed scleroderma renal crisis, one developed an adenocarcinoma, and two withdrew from the study.

The study was sponsored in part by The Road Back Foundation and NIH. The results of this small open label study must be interpreted with extreme caution.

These results do not represent a "cure" for scleroderma as was reported by CNN. Scleroderma is a disease of excessive skin and internal organ fibrosis. The mechanism by which minocycline might alter this process is not known. Minocycline has previously been reported to modestly improve joint symptoms in rheumatoid arthritis. Although this drug has a broad spectrum of antibiotic properties, the response of scleroderma patients does not necessarily implicate a microbrial etiology to scleroderma. As with many other tetracycline derivatives, minocycline has been documented to have many other pharmacologic properties, including inhibition of matrix metalloproteases.

May 14, 1998

Nancy Lane, MD
Elliott Rosenstein, MD
Co-editors, ACR Hotline

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