Combining hydroxychloroquine and minocycline: potential role in moderate to severe COVID-19 infection

ABSTRACT

Introduction

Patients with moderate to severe COVID-19 infection require specific drugs to prevent the morbidity and mortality. Hydroxychloroquine (HCQ) has shown some promise in the management of COVID 19. Minocycline, because of its anticytokine and other useful properties can be an ideal candidate for combining with HCQ.

Areas covered

Here we review the need and mechanisms and reasons for combining HCQ and minocycline moderate to severe COVID-19 infection. We also reviewed the advantages, potential safety concerns and precautions to be taken, while combining HCQ and minocycline.

Expert opinion

Combining HCQ and minocycline offers many advantages in the management of moderate to severe COVID-19 infection. Both drugs are cheaper, widely available and long-term safety data and contraindications are well known. We do not recommend this combination for prophylaxis or use in asymptomatic or mild disease patients as this can lead to unnecessary safety concerns. Additive antimicrobial and anticytokine effects of both drugs may reduce the morbidity and mortality among patients with COVID-19 and may act as a cheaper alternative to the costlier drugs, however, thorough clinical research is warranted. We call upon public and private healthcare bodies to come up with large well-designed clinical studies for generating evidence-based recommendations.

KEYWORDS:

• Cytokines
• HCQ
• IL-6
• immunomodulator
• SARS-CoV-2
• tetracycline

Article Highlights

• Use of hydroxychloroquine (HCQ) alone or in combination with azithromycin has led to never ending debate about the efficacy and safety of the above. Most of the latest data indicate that HCQ alone is not efficacious and concurrent use with azithromycin can lead to toxicity concerns particularly, cardiotoxicity. Hence, a potentially safer drug with promising activity against COVID-19, may offer additive action along with HCQ.

• Minocycline may act as a potential therapy for COVID-19 treatment as it possesses significant anticytokine and anti-inflammatory activities. Combined with HCQ, which has anticytokine and anti-COVID effect, it can be specifically helpful in management of moderate to severe COVID-19 infection and this combination may be useful in preventing the morbidity and complications.

• Because of their mutually beneficial effects in moderate to severe COVID-19 infection, combination of HCQ and minocycline offers a significant potential to be repositioned as a promising therapy for the same.

• Both minocycline and HCQ are cheaper, orally active and widely available drugs with suitable pharmacokinetics and widely known safety concerns including drug interactions and contraindications.

• Considering the above points, large well-planned clinical studies may be initiated by the government and private healthcare institutions to generate the evidence for the use of minocycline and HCQ combination in patients with moderate to severe COVID-19 infection. In addition to this, every possible support should be provided the funding authorities and drug regulatory bodies.

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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.