Introduction: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly grown into a public health emergency that has placed the national health systems as well as scientific research communities under enormous pressures. Drug repurposing or repositioning is a well-known strategy that seeks to deploy existing licensed drugs for newer indications and provides the quickest possible transition from bench to clinics for unmet therapeutic needs. Given the current, urgent, and dire need for effective therapies against novel coronavirus-19, this approach is particularly appealing. Areas covered: Here, we review the significant anti-inflammatory, immunomodulatory, and antiviral properties of minocycline as potential mechanisms for efficacy against the novel coronavirus and highlight the promises and pitfalls of this approach. Expert opinion: As compared to other agents being investigated for COVID-19, minocycline offers distinct advantages in terms of potential efficacy in patients with life-threatening acute respiratory distress syndrome (ARDS) and myocardial injury, well-known safety and interaction profile, relatively low costs, and widespread availability. We call upon public and private funders to facilitate urgent and rigorous research efforts before evidence-based recommendations for its widespread use can be made.

BackgroundCinnamomum cassia iswidely used as a traditional medicinal plant for the treatment of rheumatoid arthritis.ObjectiveThe present study aimed to assess the anti-arthritic activity of C. cassia bark hydroalcoholic extract (CCHE) in different arthritic animal models.MethodsIn formaldehyde model, sub-plantar administration of 0.1 ml of formaldehyde (2% v/v) into the right hind paws of Wistar albino rats on days 0 and 3. The rats were divided into six groups as follows: normal control, disease control, indomethacin group (3 mg/kg, p.o.) and three groups, treated with 50, 100 and 200 mg/kg CCHE (p.o.). Joint diameter was measured, and ankle joints were collected for MDA and GSH measurements. In complete Freund's adjuvant (CFA)-induced arthritis model, CFA was injected into the sub-plantar surface of the right hind paw in rats. Joint diameter was measured, and serum TNF-α and IL-1β were measured. Histopathological and immunohistochemical analyses were also performed.ResultsCCHE treatment significantly (p < 0.01) reduced MDA levels and joint swelling in a concentration-dependent manner in rats with formaldehyde-induced arthritis, in which GSH levels were elevated (p < 0.01). In rats with CFA-induced arthritis, CCHE treatment significantly reduced joint swelling as well as IL-1β and TNF-α levels (p < 0.01). TNF-α receptor expression was decreased in rats treated with indomethacin or CCHE.ConclusionBased on these findings, it can be concluded that C. cassia possesses anti-arthritic properties.

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As mortality and morbidity from novel coronavirus disease (COVID-19) continue to mount worldwide, the scientific community as well as public health systems are under immense pressure to contain the pandemic as well as to develop effective medical countermeasures. Meanwhile, desperation has driven prescribers, researchers as well as administrators to recommend and try therapies supported by little or no reliable evidence. Recently, hydroxychloroquine-sulfate (HCQS) has got significant media and political attention for the treatment as well as prophylaxis of COVID-19 despite the lack of convincing and unequivocal data supporting its efficacy and safety in these patients. This has unfortunately, yet foreseeably led to several controversies and confusion among the medical fraternity, the patient community as well as the general public. Based on the available studies, many with high risk of bias, relatively small sample sizes, and abbreviated follow-ups, HCQS is unlikely to be of dramatic benefit in COVID-19 patients and yet has the potential to cause harm, particularly when used in combination with azithromycin or other medications in high risk individuals with comorbidities. Although definitive data from larger well-controlled randomized trials will be forthcoming in the future, and we may be able to identify specific patient subpopulations likely to benefit from hydroxychloroquine, till that time it will be prudent to prescribe it within investigational trial settings with close safety monitoring. Here we review the current evidence and developments related to the use of HCQS in COVID-19 patients and highlight the importance of risk-benefit assessment and rational use of HCQS during this devastating pandemic.

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