Periostat® is a systemically delivered collagenase inhibitor available as a 20 mg capsule of doxycycline hyclate for oral administration. Periostat, administered BID, reduces the elevated collagenase activity in the gingival crevicular fluid of patients with adult periodontitis.

A randomized, multicenter, double blind study that compared the efficacy of scaling and root planing plus placebo to scaling and root planing plus Periostat administered BID for 9 months, revealed statistically significant benefits of adjunctive Periostat use with regard to reducing probing depths (for initial depths > 7 mm, 1.20 mm versus 1.68 mm; at depths 4 to 6 mm, 0.69 mm versus 0.95 mm) and gain of clinical attachment (for initial depths > 7 mm, 1.17 mm versus 1.55 mm; at depths 4 to 6 mm, 0.86 mm versus 1.03 mm).

The magnitude of these changes was small (0.17 mm to 0.48 mm), and patients were required to use Periostat BID for the duration of the study. The net changes are considered limited alterations in patients with moderate to advanced periodontitis. Therefore, the clinician must consider the expected results in view of the severity of the defects being treated and the patient's expectations.

At present, the Academy is not aware of any available data concerning the need for further surgical or non-surgical treatment of sites after using Periostat. Changes in probing depths and/or attachment gain may be so small that full disclosure of additional therapeutic needs must be discussed with the patient. There are also no studies to the Academy's knowledge which address the use of Periostat in the treatment of diseases other than adult periodontitis or specific types of periodontal defects. Furthermore, long-term (> 1 year) data regarding treatment outcomes are not available.

Therefore, it appears that Periostat has not been shown to be a substitute for meticulous home care, routine cleanings, and appropriate treatments designed to minimize bacterial load and facilitate proper home care. However, each practitioner must determine the usefulness of Periostat in light of the available data and the needs of the individual patient.