A Cochrane review [Abstract] 1 included 39 RCTs with a total of 6 013 subjects. Meta-analysis was rarely possible because of the lack of data and different outcome measures and trial durations. Although minocycline was shown to be an effective treatment for moderate to moderately-severe acne vulgaris, there was no evidence that it is better than any of the other commonly-used acne treatments. One company-sponsored RCT found minocycline to be less effective than combination treatment with topical erythromycin and zinc. No trials have been conducted using minocycline in those participants whose acne is resistant to other therapies. There is no evidence to guide what dose should be used.
For the additional review of adverse effects, 16 studies were indentified, of which 3 used a number of different designs simultaneousl; 3 studies used nationally-reported pharmacovigilence data, 4 examined cohorts of consecutive participants attending clinics, large prescribing databases were the subject of 2 cohort studies and 3 case-control studies, and 7 were systematic reviews. The evidence suggests that minocycline is associated with more severe adverse effects than doxycycline. Minocycline, but not other tetracyclines, is associated with lupus erythematosus, but the risk is small: 8.8 cases per 100 000 person-years. The risk of autoimmune reactions increases with duration of use. The evidence does not support the conclusion that the more expensive extended-release preparation is safer than standard minocycline preparations.
Comment: The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment).
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