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Alzheimer disease (AD) affects an estimated 50 million people worldwide, but there are no known disease-modifying treatments available. The anti-inflammatory tetracycline antibiotic minocycline inhibits microglia, reduces neuropathology and deficits in transgenic mouse AD models, and is a credible candidate for repurposing in AD modification. In a double-blind randomized clinical trial including 544 participants with very mild AD based in the UK National Health Service, Howard and coauthors found that 2 years of treatment with the highest tolerable minocycline doses (400 mg/d) gave no benefits on cognitive or functional decline and was poorly tolerated in this population. Despite promising preclinical data, minocycline should not be investigated further as a treatment for symptomatic AD. Editorial perspective is provided by Schneider.
Highlights. JAMA Neurol. 2020;77(2):149. doi:10.1001/jamaneurol.2019.3183
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