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Editorial
November 18, 2019

Pragmatic Trials and Repurposed Drugs for Alzheimer Disease

Author Affiliations
  • 1Keck School of Medicine, the University of Southern California, Los Angeles
JAMA Neurol. 2020;77(2):162-163. doi:10.1001/jamaneurol.2019.3784

Howard and colleagues report1 a randomized clinical trial in which 554 patients clinically diagnosed with early Alzheimer disease were randomized to 200 mg/d or 400 mg/d of the broad-spectrum antibiotic minocycline or to placebo and followed up for 24 months. Clinical outcomes were a structured Mini-Mental State Examination (MMSE)2 and the Bristol Activities of Daily Living scale. About 62% of the 200 mg/d minocycline–treated group compared with 64% of the placebo-treated group completed 2 years of treatment; only 29% of the group receiving 400 mg/d of minocycline completed the trial. There was no evidence for efficacy of minocycline at either dose. Planned subset and sensitivity analyses to assess predictors of outcomes and potential sources of bias (eg, dropout bias) did not suggest that outcomes could have been different.

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