Minocycline

Minocycline (pronounced: mi-noe-sye-kleen) is an oral antibiotic used to treat acne. It’s being developed for use in people with MS.

Current phase of trial: phase II

Type of MS: relapsing remitting MS and those with a first MS-like incident.

Research into: preventing damage caused by MS

How is it taken? As a tablet by mouth twice a day

• How does it work?
• Latest research
• Side effects
• How does it compare to current therapies?
• Further work
• When is it likely to be available?

How does it work?

Minocycline is commonly used to treat bacterial infections including acne, respiratory and urinary tract infections. Minocycline is in a class of medications called tetracycline antibiotics.

It works by preventing the growth and spread of bacteria. Recent studies have demonstrated it has anti-inflammatory properties, which may be helpful in preventing the inflammation which causes damage in the brain and spinal cord in people with MS.

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Latest research

A phase II clinical trial involving 40 people with relapsing remitting MS tested the effects of minocycline as an add-on therapy to Copaxone reported in 2009.

The study showed that there was more than a 60 per cent reduction in new lesions in people taking the combination treatment (compared with those taking Copaxone alone).

The study authors concluded that minocycline used in combination with Copaxone may be beneficial for people with MS and that further study was required.

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What are the side effects?

Common side effects in people treated with minocycline include diarrhoea, dizziness or lightheadedness, grey discoloration of the skin or tissue in the mouth including the teeth, sun sensitivity and fungal infections.

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How does it compare with current therapies?

Minocycline has not been compared with current therapies in clinical trials.

It is being tested for use as an add-on (combination) therapy with beta-interferon and with Copaxone at present.

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What further work is going on?

• A phase III trial (clinicaltrials.gov identifier: NCT00666887) is recruiting in Canada and aims to involve 200 people. The goal of the study is to test the effectiveness of minocycline at delaying the time from the first attack of MS symptoms to clinically definite MS (based on a second relapse or specific changes on MRI brain scans). This trial is due to complete in December 2015.
• A phase II trial (clinicaltrials.gov identifier: NCT01134627) is ongoing in Canada and aims to recruit 45 people with optic neuritis. The trial is open label (meaning that there will be no placebo treatment) and will measure recovery of the optic nerve in people with MS who have optic neuritis. The trial is due to complete in February 2013.

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When is it likely to be available?

Minocycline is currently licensed for other conditions but is not licensed for MS.

If the phase III trail is successful, it may be necessary to carry out further studies to assess the effectiveness of minocycline in larger numbers of people.

This will take several years to complete.

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