Minocycline at 2 Different Dosages vs Placebo for Patients With Mild Alzheimer Disease: A Randomized Clinical Trial
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Importance: There are no disease-modifying treatments for Alzheimer disease (AD), the most common cause of dementia. Minocycline is anti-inflammatory, protects against the toxic effects of β-amyloid in vitro and in animal models of AD, and is a credible repurposed treatment candidate. Objective: To determine whether 24 months of minocycline treatment can modify cognitive and functional decline in patients with mild AD. Design, Setting, and Participants: Participants were recruited into a double-blind randomized clinical trial from May 23, 2014, to April 14, 2016, with 24 months of treatment and follow-up. This multicenter study in England and Scotland involved 32 National Health Service memory clinics within secondary specialist services for people with dementia. From 886 screened patients, 554 patients with a diagnosis of mild AD (Standardised Mini-Mental State Examination [sMMSE] score ≥24) were randomized. Interventions: Participants were randomly allocated 1:1:1 in a semifactorial design to receive minocycline (400 mg/d or 200 mg/d) or placebo for 24 months. Main Outcomes and Measures: Primary outcome measures were decrease in sMMSE score and Bristol Activities of Daily Living Scale (BADLS), analyzed by intention-to-treat repeated-measures regression. Results: Of 544 eligible participants (241 women and 303 men), the mean (SD) age was 74.3 (8.2) years, and the mean (SD) sMMSE score was 26.4 (1.9). Fewer participants completed 400-mg minocycline hydrochloride treatment (28.8% [53 of 184]) than 200-mg minocycline treatment (61.9% [112 of 181]) or placebo (63.7% [114 of 179]; P < .001), mainly because of gastrointestinal symptoms (42 in the 400-mg group, 15 in the 200-mg group, and 10 in the placebo group; P < .001), dermatologic adverse effects (10 in the 400-mg group, 5 in the 200-mg group, and 1 in the placebo group; P = .02), and dizziness (14 in the 400-mg group, 3 in the 200-mg group, and 1 in the placebo group; P = .01). Assessment rates were lower in the 400-mg group: 68.4% (119 of 174 expected) for sMMSE at 24 months compared with 81.8% (144 of 176) for the 200-mg group and 83.8% (140 of 167) for the placebo group. Decrease in sMMSE scores over 24 months in the combined minocycline group was similar to that in the placebo group (4.1 vs 4.3 points). The combined minocycline group had mean sMMSE scores 0.1 points higher than the placebo group (95% CI, -1.1 to 1.2; P = .90). The decrease in mean sMMSE scores was less in the 400-mg group than in the 200-mg group (3.3 vs 4.7 points; treatment effect = 1.2; 95% CI, -0.1 to 2.5; P = .08). Worsening of BADLS scores over 24 months was similar in all groups: 5.7 in the 400-mg group, 6.6 in the 200-mg group, and 6.2 in the placebo groups (treatment effect for minocycline vs placebo = -0.53; 95% CI, -2.4 to 1.3; P = .57; treatment effect for 400 mg vs 200 mg of minocycline = -0.31; 95% CI, -0.2 to 1.8; P = .77). Results were similar in different patient subgroups and in sensitivity analyses adjusting for missing data. Conclusions and Relevance: Minocycline did not delay the progress of cognitive or functional impairment in people with mild AD during a 2-year period. This study also found that 400 mg of minocycline is poorly tolerated in this population. Trial Registration: isrctn.org Identifier: ISRCTN16105064.
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Minocycline did not delay the progression of cognitive impairment in people with mild AD over a 2-year period in a multicentre clinical trial.
“Minocycline, a tetracycline antibiotic which protects against the toxic effects of β -amyloid in vitro and in animal models of AD, did not delay the progression of cognitive impairment in people with mild AD over a 2-year period in a multicentre clinical trial.(364)”
From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [364]
In a transgenic AD mouse model, minocycline prevented Aβ deposition and neuronal death, reduced tau phosphorylation and aggregation, and improved cognitive deficits.
“In a transgenic AD mouse model, minocycline prevented Aβ deposition and neuronal death, reduced tau phosphorylation and aggregation, and improved cognitive deficits; however, it failed to delay disease progression in individuals with mild AD in a clinical trial.542”
From Role of neuroinflammation in neurodegeneration development (2023) · cites this paper as [542]
Minocycline failed to delay disease progression in individuals with mild AD in a clinical trial.
“however, it failed to delay disease progression in individuals with mild AD in a clinical trial.542”
From Role of neuroinflammation in neurodegeneration development (2023) · cites this paper as [542]
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- Authors
- Howard, R., Zubko, O., Bradley, R., Harper, E., Pank, L., O’Brien, J., Fox, C., Tabet, N., Livingston, G., Bentham, P., McShane, R., Burns, A., Ritchie, C., Reeves, S., Lovestone, S., Ballard, C., Noble, W., Nilforooshan, R., Wilcock, G., Gray, R., & for the Minocycline in Alzheimer Disease Efficacy (MADE) Trialist Group
- Affiliations
- University College London (GB)
- King's College London (GB)
- University of Oxford (GB)
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- University of East Anglia (GB)
- University of Sussex (GB)
- National Health Service (GB)
- University of Manchester (GB)
- University of Edinburgh (GB)
- University of Exeter (GB)
- Corresponding author
- Howard, Robert
- ORCID
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2020-02-01
- Volume
- 77
- Issue
- 2
- Pages
- 164
- ISSN
- 2168-6149 (ISSN-L)
- PMC
- PMC6865324
- OpenAlex
- W2984563923
- Cited by
- 194
- References
- 33
- Citations by year
- 2026: 24 · 2025: 22 · 2024: 30 · 2023: 26 · 2022: 38 · 2021: 26 · 2020: 26 · 2019: 2
- FWCI
- 15.78
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- JAMA Neurology (publishedVersion, cc-by)
- Research Portal (King's College London) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Royal Devon and Exeter Research Repository (Royal Devon and Exeter) (submittedVersion)
- Funders
- South London and Maudsley NHS Foundation Trust
- Sussex Partnership NHS Foundation Trust
- National Institute for Health and Care Research (NF-SI-0616-10042, NIHR/CS/010/019)
- St George's University Hospitals NHS Foundation Trust
- Oxford Health NHS Foundation Trust
- Medical Research Council
- Topics
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pharmacology › Cholinesterase and Neurodegenerative Diseases
- Keywords
- minocycline, Alzheimer's disease, mild Alzheimer disease, disease-modifying therapy, drug repurposing, anti-inflammatory therapy, amyloid-beta, cognitive decline, functional decline, activities of daily living, dose comparison, gastrointestinal adverse effects, dermatologic adverse effects, dizziness, medication adherence, memory clinics, dementia services, Mini-Mental State Examination
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Alzheimer Disease, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Minocycline, Treatment Outcome, Disease Progression, Neuroprotective Agents
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