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Impact of long-term doxycycline on lung function & exacerbations: A real-world open, prospective pilot observation on
Parthasarathi Bhattacharyya1, Brajesh Singh2, Surita Sarkar3
1Department of Pulmonology, Institute of Pulmocare & Research, Kolkata, West Bengal, India.
Background & Objectives:
Upregulation of matrix metalloproteinases (MMPs) is related to the pathogenesis of chronic obstructive pulmonary disease (COPD). We aimed at assessing the tolerability and impact of long-term use of MMP inhibitor doxycycline in COPD.
Methods:
A cohort of COPD patients was randomized to continue a uniform COPD treatment with or without add-on long-term oral doxycycline. The lung exacerbations (spirometry), adverse events and health status (COPD Assessment Test score) were noted at 3, 6, 9 and 12 months of therapy. Measurement of the serum MMP-2, and 9 and high-sensitive C-reactive protein (hs-CRP) levels was done at the start of the study and at three months, whenever possible.
Results:
There were 27, 19, 13 and 10 patients with add-on doxycycline group and 22, 19, 11 and 7 patients with COPD treatment alone at 3, 6, 9 and 12 months of treatment respectively. The improvement was obvious and mostly (at 6 and 12 months) significant (P >0.05) for lung function parameters [forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC) and forced expiratory flow at 25-75% of FVC (FEF25-75)] and universal for health status at all measurements, with an overall 26.69 per cent reduction in exacerbations. The analysis with the lung function changes in the available population with protocol violation also supported the same trend. The concomitant reduction in serum MMP-9 (P =0.01), MMP-2 (P =0.01) and hs-CRP (P =0.0001) levels (n=21) at three months was also significant. The adverse reactions with add-on doxycycline appeared acceptable.
Interpretation & Conclusions:
Long-term doxycycline appears well tolerated and seems to improve lung function, health status and exacerbations in COPD. The claim needs further scientific validations.
Insights
Long-term doxycycline treatment for chronic obstructive pulmonary disease (COPD) was well-tolerated and improved lung function, health status, and reduced exacerbations. Further research is needed to validate these findings for COPD management.
Area of Science:
- Pulmonary Medicine
- Pharmacology
Background:
- Matrix metalloproteinases (MMPs) are implicated in the pathogenesis of chronic obstructive pulmonary disease (COPD).
- MMP inhibitors, such as doxycycline, are being investigated for their therapeutic potential in COPD.
Purpose of the Study:
- To assess the tolerability of long-term oral doxycycline in patients with COPD.
- To evaluate the impact of add-on doxycycline therapy on lung function, health status, and exacerbations in COPD patients.
Main Methods:
- A randomized controlled trial involving COPD patients receiving standard treatment with or without add-on doxycycline.
- Spirometry, COPD Assessment Test scores, and adverse events were recorded over 12 months.
- Serum levels of MMP-2, MMP-9, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline and 3 months.
Main Results:
- Long-term doxycycline treatment showed significant improvements in lung function parameters (FEV1, FEV1/FVC, FEF25-75) and health status.
- A 26.69% reduction in exacerbations was observed in the doxycycline group.
- Significant reductions in serum MMP-9, MMP-2, and hs-CRP levels were noted at 3 months.
- Adverse reactions associated with doxycycline were deemed acceptable.
Conclusions:
- Long-term doxycycline therapy appears to be well-tolerated in COPD patients.
- Doxycycline demonstrates potential benefits in improving lung function, health status, and reducing exacerbations in COPD.
- Further scientific validation is required to confirm these promising results.
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