Oral Minocycline Therapy Improves Symptoms of Myalgic Encephalomyelitis, Especially in the Initial Disease Stage, 2021, Miwa

Abstract

Objective Central nervous system dysfunction associated with myalgic encephalomyelitis (ME) has been suggested to be the main cause of chronic fatigue syndrome. In animal models of chronic fatigue, minocycline was reported to act as a suppressor of neural inflammation. Minocycline may thus exert favorable therapeutic effects in patients with ME.

Methods Oral minocycline (100 mg ×2 on the first day, followed by 100 mg/day for 41 days) was administered to 100 patients with ME. The performance status score (0-9), orthostatic intolerance during the 10-min standing test, neurologic disequilibrium, and neuropathic pain were compared before and after treatment.

Results After therapy completion, favorable effects were observed with a decrease in the performance status score of ≥2 points in 27 patients (27%). Before treatment, 6 of the 27 patients had orthostatic intolerance with an inability to complete the 10-min standing test; after treatment, this symptom resolved in 4 and improved in 2 patients. In addition, after treatment, postural orthostatic tachycardia resolved in five of eight patients, disequilibrium resolved in five of eight patients, and fibromyalgia or neuropathic pain was attenuated in four of five patients. The favorable effects appeared dependent on a shorter disease duration, primarily for a duration of less than three years and most frequently within six months of the disease onset. However, acute adverse effects with nausea and/or dizziness caused 38 patients (38%) to discontinue treatment in the first few days.

Conclusion Oral minocycline therapy may be an effective treatment option for patients with ME, especially in the initial stage of the disease.

Open access, https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_6082-20/_article

 

The favorable effects appeared dependent on a shorter disease duration, primarily for a duration of less than three years and most frequently within six months of the disease onset.

Study participants

The inclusion criteria were as follows: an ME diagnosis based on the 2011 International Consensus Criteria (2) with over a two-month disease duration before the study

Of the 100 study patients, 36 were men, and 64 were women, with a mean age of 36±12 (16-73) years. Infectious onset was reported by 41 (41%) of the patients.
​

Among the 100 patients, 73 either dropped out due to adverse effects (38) or did not have an improvement (35).

21 out of the 27 participants for whom improvement was reported were ill for less than 3 years, i.e. within the usual recovery timeframe for a self-remitting post-infectious syndrome. Those who failed to complete the 10 min standing test before treatment but increased their time or succeeded afterwards may be cases of regression to the mean, if they were (naturally) less symptomatic on the day of the post-treatment test. This seems plausible given the severity of the patients who improved: 2 seemed severe (PS >= 8), 4 moderate (PS = 7), 15 mild / mild-moderate (3 <= PS <= 6).

Besides nausea and dizziness, minocycline has a wide range of serious adverse effects.



ETA:



The performance status (PS) score is a 10-point scale:

0 - The patient can perform the usual activities of daily living and social activities without malaise.
1 - The patient often feels fatigue.
2 - The patient often needs to rest because of general malaise or fatigue.
3 - The patient cannot work or perform usual activities for a few days in a month.
4 - The patient cannot work or perform usual activities for a few days in a week.
5 - The patient cannot work or perform usual activities but can perform light work.
6 - The patient needs daily rest but can perform light work on a “good day”.
7 - The patient can take care of himself/herself but cannot perform usual duties.
8 - The patient needs help to take care of himself/herself.
9 - The patient needs to rest the whole day and can-not take care of himself/herself without help.

 

Open label so nothing to impress here IMO.