Effect of Doxycycline on Aortic Aneurysm Growth

May 27, 2020
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Authors:
Baxter BT, Matsumura J, Curci JA, et al.
Citation:
Effect of Doxycycline on Aneurysm Growth Among Patients With Small Infrarenal Abdominal Aortic Aneurysms: A Randomized Clinical Trial. JAMA 2020;323:2029-2038.
Summary By:
Geoffrey D. Barnes, MD, MSc, FACC

Quick Takes

  • Among patients with a small AAA, doxycycline use did not slow aneurysm growth over 2 years.
  • Patients with small AAA had an average growth of 0.36 cm over 2 years.

Study Questions:

Does doxycycline reduce the growth of abdominal aortic aneurysm (AAA)?

Methods:

Patients with a small AAA (3.5-5.0 cm for men, 3.5-4.5 cm for women) at 22 centers were randomized to receive doxycycline or placebo between 2013 and 2017, and followed through July 2018. The primary outcome was a change in AAA maximum transverse diameter as measured by a computed tomography (CT) between baseline and 2-year follow-up.

Results:

Of the 254 patients randomized and with follow-up CT scans (97% of original study population), the mean age was 71.0 years (standard deviation, 7.4 years) and 35 (14%) were women. The change in maximum transverse diameter did not differ between the two treatment groups (0.36 cm in both groups). AAA repair occurred in 13 (10%) patients in the doxycycline group and 9 (7%) in the placebo group. No rupture occurred in either group. Study drug discontinuation due to adverse event occurred in 22/129 (17%) patients randomized to doxycycline and 9/125 (7%) patients randomized to placebo.

Conclusions:

The authors concluded that among patients with a small infrarenal AAA, doxycycline did not reduce aneurysm growth at 2 years as compared to placebo.

Perspective:

There has been interest in the use of tetracycline antibiotics, including doxycycline, to reduce AAA growth due to its ability to reduce inflammation and matrix metalloproteinases. Prior studies have had conflicting results, potentially due to differences in baseline group demographics (male vs. female) and aneurysm size. This study of patients with small infrarenal AAA did not find any benefit to daily doxycycline use over 2 years. While these findings may be disappointing for identifying a preventative therapy for patients with AAA, they also highlight two important facts: 1) average growth over 2 years was slightly <0.5 cm, and 2) <10% of all randomized patients required AAA repair. These data can be useful when advising patients about the natural history of their small infrarenal AAA.

Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and Imaging, Interventions and Vascular Medicine, Computed Tomography, Nuclear Imaging

Keywords: Anti-Bacterial Agents, Aorta, Abdominal, Aortic Aneurysm, Abdominal, Cardiac Surgical Procedures, Diagnostic Imaging, Doxycycline, Geriatrics, Inflammation, Matrix Metalloproteinases, Primary Prevention, Tomography, X-Ray Computed, Vascular Diseases


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