NSAIDs not associated with more severe coronavirus disease, study finds

September 08, 2020

The use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and diclofenac, is not associated with any adverse effects in people who have tested positive for COVID-19, according to a new study published September 8 in PLOS Medicine by Anton Pottegård of the University of Southern Denmark and colleagues from Aarhus University Hospital and the Danish Medicines Agency.

During the early phases of the COVID-19 pandemic, concerns were raised that the use of the painkiller ibuprofen may lead to a more severe course of coronavirus disease. As use of ibuprofen and other NSAIDs is widespread, data on their safety is urgently needed to guide clinicians and patients. In the new study, researchers obtained data on all 9,326 Danish residents who tested positive for the SARS-CoV-2 virus between February 27, 2020 and April 29, 2020. Data were available on NSAID use, 30-day mortality, hospitalization, ICU admission, mechanical ventilation, and acute renal replacement therapy. 248 people (2.7%) had filled a prescription for NSAIDs within 30 days of their positive virus test.

The researchers found no association between any of the outcomes and NSAID use. Among NSAID users in a matched cohort who tested positive for the coronavirus, 6.3% (95% Confidence Interval [CI] 3.1-9.4) died, 24.5% (95% CI 18.6-30.4) were hospitalized and 4.9% (95% CI 2.1-7.8) were admitted to ICU. Of those who tested positive for the coronavirus but were not treated with NSAIDs, 6.1% (95% CI 4.4-7.8) died, 21.2% (95% CI 18.1-24.3) were hospitalized, and 4.7% (95% CI 3.2-6.2) were admitted to ICU. None of these differences between groups were statistically significant (mortality Risk Ratio [RR] 1.02, 95%CI 0.57-1.82, p=0.95; hospitalization RR 1.16, 95%CI 0.87-1.53, p=0.31; ICU admission RR 1.04, 95%CI 0.54-2.02, p = 0.90).

"Considering the available evidence, there is no reason to withdraw well-indicated use of NSAIDs during the SARS-CoV-2 pandemic," the authors say. "However, the well-established adverse effects of NSAIDs, particularly their renal, gastrointestinal, and cardiovascular effects, should always be considered, and NSAIDs should be used in the lowest possible dose for the shortest possible duration for all patients."
Research Article

Peer reviewed; Experimental study; People

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003308

Funding: The authors received no specific funding for this work.

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: KBK, NBJ, SC, NB, declare no conflicts of interest. RWT and CFC declare no personal conflicts of interest, yet the Department of Clinical Epidemiology is involved in studies with funding from various companies as research grants to and administered by Aarhus University. None of these studies are related to the current study. HS reports personal fees from Bristol-Myers Squibb, personal fees from Novartis, personal fees from Roche, outside the submitted work. AP and JH report participation in research funded by Alcon, Almirall, Astellas, AstraZeneca, Boehringer-Ingelheim, Novo Nordisk, Servier and LEO Pharma, all with funds paid to the institution where they were employed (no personal fees) and with no relation to the work reported in this paper. LCL reports participation in research projects funded by Menarini Pharmaceutical and LEO Pharma, with funds paid to the institution where he was employed (no personal fees) and with no relation to the work reported in this paper. MR reports participation in research projects funded by LEO Pharma, with funds paid to the institution where she was employed (no personal fees) and with no relation to the work reported in this paper.

Citation: Lund LC, Kristensen KB, Reilev M, Christensen S, Thomsen RW, Christiansen CF, et al. (2020) Adverse outcomes and mortality in users of non-steroidal anti-inflammatory drugs who tested positive for SARS-CoV-2: A Danish nationwide cohort study. PLoS Med 17(9): e1003308. https://doi.org/10.1371/journal.pmed.1003308


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