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Ursodiol has been the most promising therapy for primary sclerosing cholangitis (PSC), but recent studies suggest that it has no greater effect on survival than placebo (JW Gastroenterol Jan 31 2006). The pathogenesis of PSC remains unclear, but immunologic disturbance and overexpression of inflammatory mediators are probably key components. Minocycline has not only antimicrobial activity but also anti-inflammatory and antiapoptotic properties, providing the rationale for studying its efficacy in PSC.
In an open-label pilot study, 16 patients (median age, 50; 31% women) with PSC received minocycline (100 mg twice daily). All participants were required to have a serum alkaline phosphatase level >1.5 times the upper limit of normal and cholang…