Concomitant use of dexamethasone and tetracyclines: a potential therapeutic option for the management of severe COVID-19 infection?

ABSTRACT

Introduction: The global coronavirus disease-2019 (COVID-19) pandemic has posed a critical challenge to the research community as well as to the healthcare systems. Severe COVID-19 patients are at a higher risk of developing serious complications and mortality. There is a dire need for safe and effective pharmacotherapy for addressing unmet needs of these patients. Concomitant use of dexamethasone and tetracyclines, by virtue of their immunomodulatory and other relevant pharmacological properties, offers a potential strategy for synergy aimed at improving clinical outcomes.

Areas covered: Here we review the potential benefits of combining dexamethasone and tetracyclines (minocycline or doxycycline) for the management of severe COVID-19 patients. We have critically examined the evidence obtained from in silico, experimental, and clinical research. We have also discussed the plausible mechanisms, advantages, and drawbacks of this proposed combination therapy for managing severe COVID-19.

Expert opinion: The concomitant use of dexamethasone and one of the tetracyclines among severe COVID-19 patients offers several advantages in terms of additive immunomodulatory effects, cost-effectiveness, wide-availability, and well-known pharmacological properties including adverse-effect profile and contraindications. There is an urgent need to facilitate pilot studies followed by well-designed and adequately-powered multicentric clinical trials to generate conclusive evidence related to utility of this approach.

KEYWORDS:

• Cytokines
• doxycycline
• glucocorticoids
• minocycline
• sars-CoV-2

Article highlights

•Severe COVID-19 infections pose a significant challenge to the worldwide healthcare systems owing to their high morbidity and mortality.

•Here we review the potential of concomitant use of dexamethasone and one of the tetracyclines (minocycline or doxycycline) for treating patients with severe COVID-19 infection based on the evidence available from experimental–in silico, in vitro, and clinical studies.

•Both dexamethasone and tetracyclines have potent immunomodulatory effects and other favorable pharmacological actions which can address the pathogenic pathways and mediators involved in severe COVID-19 infection.

•Both these agents complement each other on account of their pharmacological properties, cost-effectiveness, and well-known adverse effect profile.

•Based on the potential advantages of concomitant use of dexamethasone and tetracyclines for the management of severe COVID-19 infection, we urge academic institutions, public and private healthcare organizations and funders to facilitate well-designed clinical studies in order to generate conclusive evidence to support or refute the utility of this approach.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.