periostat bottle

Collagenase inhibitor drug

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Adding Periostat to scaling and root planing increases clinical attachment gain by 71%*

Mechanism of action

Periostat helps to reduce the over-production of collagenase (enzymes responsible for the destructIon of collagen) and osteoclasts (bone cell responsible for the resorption of bone) that are present in overabundance during a chronic, prolonged and destructive inflammatory response. This exaggerated inflammatory response is common among chronic inflammatory diseases such as periodontitis, cardiovascular disease and rheumatoid arthritis. Therefore, Periostat, when used (BID) for 6 to 9 months, helps to modulate the chronic, prolonged and destructive inflammatory response into a normal and healthy inflammatory response process.

chronic prolonged inflammation plus periostat equal healthy inflammation/greater tissue repair

Indications

Collagenase inhibitor for periodontal use.
Ideal for these situations :
• Cardiovascular disease14-17
• Diabetes22, 23
• Genotype-positive 25
• Post-menopausal osteoporosis18, 21 24
• Rheumatoid arthritis13
• Smokers7
• Severe and rapidly progressing periodontitis cases1-12, 19

Active Ingredient

Doxycycline Hyclate (20mg)

DIN

02247104

Directions for use

Adults
Twice daily, 1 hour prior to morning and evening meals
Take the capsule with a full glass of water.

Warnings

Periostat is well tolerated with side effects similar to placebo groups.1-6
Periostat does not cause sun sensitivity, nausea or antibiotic resistance.

Contraindications :
• Absorption of doxycycline is impaired by antacids containing aluminum, calcium, or magnesium, and iron-containing preparations.
• Absorption is also impaired by bismuth subsalicylate.
• Barbiturates, carbamazepine and phenytoin decrease the half-life of doxycycline.
• Pregnant or nursing women, children, tetracycline intolerant individuals or liver disease sufferers should not take Periostat.

graph showing doxycycline concentration per hours

Consult the product monograph for important information relating to adverse reactions, drug interactions and dosing information which have not been discussed in this piece.

table showing side effects are comparable to placebo

From the journal of the American Dental Association

JADA 146(7) http://jada.ada.org July 2015 p. 525-535
A panel of experts convened by the American Dental Association Council on Scientific Affairs presented an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis.*

The Council voted only in favor of two clinical recommendations as nonsurgical treatments for chronic periodontitis:
  • Scaling and root planing without adjunct (SRP)
  • SRP + subantimicrobial-dose doxycycline (Periostat)

ada and jada logo
table showing the two clinical recommendations

Adding subantimicrobial-dose doxycycline to SRP increases clinical attachment gain by 71 %

table showing SRP with adjuncts is more effective

SUBANTIMICROBIAL-DOSE DOXYCYCLINE IS PROVEN TO BE MORE EFFECTIVE THAN SRP + PLACEBO EVEN IN PERIODONTITIS PATIENTS WITH THESE DIFFICULT CONDITIONS

Chronic Periodontitis

• Significantly more effective than SRP + Placebo & NO antibiotic side-effects.1,2,4,10
• 75% fewer teeth lost than patients treated with SRP + Placebo.5
• 90% reduction of “active” pockets (those that get deeper with time).3,5,7,8,9,11,12
• No “rebound” effect.1,6
• 50 to 60% reduction of biologic mediators of tissue breakdown and bone resorption (ie. MMP-8/ collagenase, MMP-9 & IL-1β).1,19
• In quickly progressing periodontitis, adjunctive SDD (versus adjunctive placebo) produced a 73% reduction in “active” pockets, a 2 to 3 times greater mean attachment gain (ie. 2.2 mm vs 0.8 mm) & significant reduction of BOP.2,8

Periodontitis & rheumatoid arthritis

• Rheumatoid arthritis patients (RA) treated with “standard-of-care”, methotrexate, show 3 times greater reduction of RA severity when also treated with SDD for 2 years & NO side-effects due to SDD13

Periodontitis & cardiovascular disease

• Improvement in periodontal disease with SDD.14,15,16,17
• Improvement in diagnostic risk-factors for cardiovascular disease (CVD); reduction of blood levels of C-reactive protein, IL-6 & MMP-9 & increase in good cholesterol (HDL)) with SDD.14

image of body showing organs affected by periodontitis

Periodontitis & post-menopausal osteoporosis

• SDD + Periodontal maintenance therapy for 2 years shown reduction of periodontal disease severity assessed clinically, radiologically, and biochemically.18,19,20,21
• SDD for 2 years reduced diagnostic biomarkers of skeletal bone resorption with no effect on biomarkers of bone formation (blood biomarkers) & a reduced risk for osteoporosis.24

Periodontitis & diabetes

• Improvement in periodontal disease with SDD + SRP.
• Reduction in blood levels of Hemoglobin A1C to a near-normal level with SDD + SRP + NO side-effects.22,23

Genotype-positive

• 50-61% decrease in the IL-1B and MMP-9 was noted after 2 and 4 months compared with SRP + Placebo.25

American Academy of Periodontology

" Research has shown that periodontal disease is associated with several other diseases. For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions. "
Source: www.perio.org/consumer/other-diseases

american academy of periodontology logo

Testimonials

I just had a patient return after 2 months of Periostat. He's very compliant with recommendations and has localized severe chronic perio on the max molars. Today, I found that both sites had a significant decrease in bleeding on probing. And the deepest site, a 9mm, decreased to 6mm! I was so excited as I had no expectation of so great a result in an area of severe bone loss! It was terrific!

- Martha, a Registered Dental Hygienist

References

*JADA 146(7) http://jada.ada.org July 2015 p. 525-535.
  1. Caton J, Ryan ME., Clinical studies on the management of periodontal diseases utilizing subantimicrobial dose doxycycline (SDD), Pharmacol Res. 2011 Feb;63(2):114-20. [download]
  2. Ashley RA., Clinical trials of a matrix metalloproteinase inhibitor in human periodontal disease, SDD Clinical Research Team. Ann, NY Acad Sci. 1999 Jun 30;878:335-46. [link]
  3. Lee JY, Lee YM, Shin SY, Seol YJ, Ku Y, Rhyu IC, Chung CP, Han SB., Effect of subantimicrobial dose doxycycline as an effective adjunct to scaling and root planing, J Periodontol. 2004 Nov;75(11):1500-8. [download]
  4. Preshaw PM., Host response modulation in periodontics. Periodontol 2000. 2008;48:92-110. [download]
  5. Caton JG, Ciancio SG, Blieden TM, et al., Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis, J Periodontol 2000:71:521-32. [link]
  6. Caton JG, Ciancio SG, Blieden TM, Bradshaw M, Crout RJ, Hefti AF, Massaro JM, Polson AM, Thomas J, Walker C., Subantimicrobial dose doxycycline as an adjunct to scaling and root planing: post-treatment effects, J Clin Periodontol. 2001 Aug;28(8):782-9. [link]
  7. Preshaw PM, Hefti AF, Bradshaw MH. , Adjunctive subantimicrobial dose doxycycline in smokers and non-smokers with chronic periodontitis, J Clin Periodontol. 2005 Jun;32(6):610-6. [link]
  8. Novak MJ, Johns LP, Miller RC, et al., Adjunctive benefits of subantimicrobial dose doxycycline in the management of severe, generalized, chronic periodontitis, J Periodontol. 2002 Jul;73(7):762-9. [link]
  9. Tapiainen T., Renko M., Kontiokari T., Renko M., Uhari M., Xylitol Administered Only During Respiratory Infections
Failed to Prevent Acute Otitis Media, Pediatrics. 2002 Feb;109(2):E19. [link]
  10. Mohammad AR, Preshaw PM, Bradshaw MH, Hefti AF, Powala CV, Romanowicz M., Adjunctive subantimicrobial dose doxycycline in the management of institutionalised geriatric patients with chronic periodontitis, Gerodontology. 2005 Mar;22(1):37-43. [link]
  11. Gu Y, Walker C, Ryan ME, PayneJB, Golub LM., Non-antibacterial tetracycline formulations: clinical applications in dentistry and medicine, J Oral Microbiol. 2012;4: doi: 10.3402/jom.v4i0.19227. [link]
  12. Novak MJ, Dawson DR 3rd, Magnusson I, Karpinia K, Polson A, Polson A, Ryan ME, Ciancio S, Drisko CH, Kinane D, Powala C, Bradshaw M., Combining host modulation and topical antimicrobial therapy in the management of moderate to severe periodontitis: a randomized multicenter trial, J Periodontol. 2008 Jan;79(1):33-41. 12. [download]
  13. Preshaw PM, Hefti AF, Novak MJ, Michalowicz BS, Pihlstrom BL, Schoor R, Trummel CL, Dean J, Van Dyke TE, Walker CB, Bradshaw MH., Subantimicrobial dose doxycycline enhances the efficacy of scaling and root planing in chronic periodontitis: a multicenter trial, J Periodontol. 2004 Aug;75(8):1068-76. [link]
  14. O'Dell JR, Elliot JR, Mallek JA, Mikuls TR, Weaver CA, Glickstein S, et al., Treatment of early seropositive rheumatoid arthritis: doxycycline plus methotrexate alone, Arthritis Rheum. 2006;54:621-7. [link]
  15. Brown DL, Desai KK, Vakili BA, Nouneh C, Lee HM, Golub LM., Clinical and biochemical results of the metalloproteinase inhibition with subantimicrobial doses of doxycycline to prevent acute coronary syndromes (MIDAS) pilot trial, Arterioscler Thromb Vasc Biol. 2004 Apr;24(4):733-8. [link]
  16. Tüter G, Kurtiş B, Serdar M, Aykan T, Okyay K, Yücel A, Toyman U, Pinar S, Cemri M, Cengel A, Walker SG, Golub LM., Effects of scaling and root planing and sub-antimicrobial dose doxycycline on oral and systemic biomarkers of disease in patients with both chronic periodontitis and coronary artery disease, J Clin Periodontol. 2007 Aug;34(8):673-81. [link]
  17. Bench TJ1, Jeremias A, Brown DL., Matrix metalloproteinase inhibition with tetracyclines for the treatment of coronary artery disease. Pharmacol Res. 2011 Dec;64(6):561-6. [download]
  18. Payne JB, Golub LM, Stoner JA, Lee HM, Reinhardt RA, Sorsa T, Slepian MJ., The effect of subantimicrobial-dose-doxycycline periodontal therapy on serum biomarkers of systemic inflammation: a randomized, double-masked, placebo-controlled clinical trial, J Am Dent Assoc. 2011 Mar;142(3):262-73. [link]
  19. Reinhardt RA, Stoner JA, Golub LM, et al., Efficacy of subantimicrobial dose doxycycline in postmenopausal women: clinical outcomes, J Clin Periodontol 2007:34:768-75. [link]
  20. Golub LM, Lee HM, Stoner JA, et al., Subantimicrobial dose doxycycline modulates gingival crevicular fluid biomarkers of periodontitis in postmenopausal osteopenic women, J Periodontol 2008:79:1409-18. [link]
  21. Walker C, Puumala S, Golub LM, et al., Subantimicrobial dose doxycycline effects on osteopenic bone loss: microbiologic results, J Periodontol 2007:78:1590-601. [link]
  22. Payne JB, Stoner JA, Nummikoski PV, Reinhardt RA, Goren AD, Wolff MS, Lee HM, Lynch JC, Valente R, Golub LM., Subantimicrobial dose doxycycline effects on alveolar bone loss in postmenopausal women, J Clin Periodontol. 2007 Sep;34(9):776-87. [link]
  23. Engebretson SP, Hey -Hadavi J., Sub-antimicrobial doxycycline for periodontitis reduces hemoglobin A1c in subjects with type 2 diabetes: a pilot study, Pharmacol Res. 2011 Dec;64(6):624-9. [link]
  24. Engebretson SP, Hyman LG, Michalowicz BS, Schoenfeld ER, Gelato MC, Hou W, Seaquist ER, Reddy MS, Lewis CE, Oates TW, Tripathy D, Katancik JA, Orlander PR, Paquette DW, Hanson NQ, Tsai MY., The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial, JAMA. 2013 Dec 18;310(23):2523-32. [link]
  25. Golub LM, Lee HM, Stoner JA, Reinhardt RA, Sorsa T, Goren AD, Payne JB., Doxycycline effects on serum bone biomarkers in postmenopausal women, J Dent Res. 2010 Jun;89(6):644-9. [link]
  26. Ryan ME, Lee HM, Bookbinder MIC et al., Treatment of genetically susceptible patients with a subantimicrobial dose of doxycycline, Dent Res 2000:79:608 (abstract #3719).