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Lack of Efficacy for Doxycycline in Stunting Aneurysm Growth

Summary and Comment |
January 23, 2014

Lack of Efficacy for Doxycycline in Stunting Aneurysm Growth

  1. Joel M. Gore, MD

Contrary to evidence from preclinical studies, doxycycline failed to decrease growth of small AAAs in an aborted randomized trial.

  1. Joel M. Gore, MD

Doxycycline has been shown to inhibit the formation and progression of abdominal aortic aneurysms (AAAs) in animal studies and several preliminary clinical studies. To assess doxycycline's efficacy for reducing AAA growth in humans, investigators randomized 286 patients with small AAAs (mean baseline diameter, 45 mm) treated at 14 hospitals in the Netherlands to receive doxycycline (100 mg) or placebo daily for 18 months.

Based on results of an interim analysis, the trial was stopped prematurely for futility. At trial cessation, ≥1-year follow-up data were available for all patients. Demographic and clinical characteristics of the two patient groups were similar (mean age, 70; approximately 80% men; statin use, 67%).

Aneurysm growth at 18 months was not decreased with doxycycline compared with placebo. Aneurysm growth was actually higher in the doxycycline group by 0.8 mm (a statistically significant but clinically irrelevant difference); the largest between-group difference in growth occurred during the first 6-month period of the study. Rates of elective AAA repair were similar between the two groups. Treatment-related adverse events resulted in the withdrawal of 11 patients in the doxycycline group and 3 patients in the placebo group.

Comment

In this randomized trial, long-term doxycycline therapy did not stem aneurysm progression. A medical treatment to retard abdominal aortic aneurysm enlargement and obviate or delay the need for surgical repair remains elusive.

  • Disclosures for Joel M. Gore, MD at time of publication Grant / research support NIH; NIH-NHLBI; NSF

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