Prolonged administration of doxycycline in patients with small asymptomatic abdominal aortic aneurysms: Report of a prospective (Phase II) multicenter study

Background: The primary purpose of this study was to evaluate compliance, side effects, and safety associated with prolonged administration of doxycycline in patients with small asymptomatic abdominal aortic aneurysms (AAAs). A secondary goal was to determine how treatment with doxycycline influences circulating levels of matrix metalloproteinase-9 (MMP-9) in this patient population. Methods: Thirty-six patients with AAAs (30 men and 6 women; mean age, 69 ± 1 years) were enrolled into a 6-month phase II study to evaluate treatment with doxycycline (100 mg orally twice a day). Aneurysm size was measured before and after treatment, and compliance and side effects were monitored. Plasma levels of doxycycline were measured midway through the study, and plasma MMP-9 concentrations were measured at baseline, 3 months, and 6 months. Results: Thirty-three of the 36 patients (92%) completed 6 months of doxycycline treatment. Significant treatment-related side effects occurred in five patients (13.9%), including three with cutaneous photosensitivity reactions (8.3%), one with tooth discoloration (2.8%), and one with yeast infection (2.8%). A high rate of compliance with treatment was seen, despite minor but frequent side effects, including nonspecific gastrointestinal symptoms (25%), easily managed episodes of photosensitivity (22.2%), and reversible tooth discoloration (5.5%). The mean plasma doxycycline level after 3 months was 4.62 ± 0.68 ug/mL (median, 3.64 μg/mL; range, 1.31 to 14.39 μg/mL; n = 23 patients). No significant change was seen in AAA diameter (42.7 ± 1.3 mm at 6 months versus 41.0 ± 0.9 mm at baseline), and the overall rate of AAA expansion was 0.63% ± 0.25% per month. The mean plasma MMP-9 level (n = 19 patients) was elevated at baseline (118.9 ± 37.9 ng/mL; upper limit of normal, 85 ng/mL) but subsequently decreased to 83.8 ± 32.9 ng/mL at 3 months (not signifcant versus baseline) and to 66.4 ± 24.2 ng/mL at 6 months (P = .022 versus baseline). Only 21% of patients had an elevated level of plasma MMP-9 after 6 months of treatment compared with 47% at baseline (P < .05). Conclusion: Prolonged administration of doxycycline is safe and well tolerated by patients with small asymptomatic AAAs and is associated with a gradual reduction in plasma MMP-9 levels. Further studies are needed to evaluate the long-term effects of doxycycline on the rate and extent of aneurysm growth and the potential use of plasma MMP-9 levels as a biomarker of aneurysm disease progression.