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0 0.5 1 1.5 2+ Mortality -170% Improvement Relative Risk Mortality (b) 37% Oxygen therapy -45% Hospitalization -18% Severe case -85% Ibuprofen  Abu Esba et al.  EARLY TREATMENT Is early treatment with ibuprofen beneficial for COVID-19? Prospective study of 397 patients in Saudi Arabia (Apr - Jun 2020) Higher mortality (p=0.35) and severe cases (p=0.42), not sig. Abu Esba et al., Infectious Diseases a.., Nov 2020 Favors ibuprofen Favors control

Ibuprofen and NSAID Use in COVID-19 Infected Patients Is Not Associated with Worse Outcomes: A Prospective Cohort Study

Abu Esba et al., Infectious Diseases and Therapy, doi:10.1007/s40121-020-00363-w
Nov 2020  
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Prospective study of 503 COVID-19 cases in Saudi Arabia, 40 using ibuprofen during infection, and 357 not using NSAIDs, showing no significant differences in outcomes. Results are subject to confounding by indication. This study is excluded in the after exclusion results of meta analysis: substantial unadjusted confounding by indication likely.
risk of death, 169.5% higher, RR 2.70, p = 0.35, treatment 1 of 40 (2.5%), control 11 of 357 (3.1%), adjusted per study, multivariable.
risk of death, 36.8% lower, HR 0.63, p = 0.68, treatment 40, control 357, Cox proportional hazards.
risk of oxygen therapy, 44.8% higher, RR 1.45, p = 0.64, treatment 40, control 357, adjusted per study, multivariable.
risk of hospitalization, 18.2% higher, RR 1.18, p = 0.64, treatment 40, control 357, adjusted per study, multivariable.
risk of severe case, 84.8% higher, RR 1.85, p = 0.42, treatment 40, control 357, adjusted per study, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Abu Esba et al., 2 Nov 2020, prospective, Saudi Arabia, peer-reviewed, 6 authors, study period 12 April, 2020 - 1 June, 2020.
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Ibuprofen and NSAID Use in COVID-19 Infected Patients Is Not Associated with Worse Outcomes: A Prospective Cohort Study
Laila Carolina Abu Esba, Rahaf Ali Alqahtani, Abin Thomas, Nour Shamas, Lolowa Alswaidan, Gahdah Mardawi
Infectious Diseases and Therapy, doi:10.1007/s40121-020-00363-w
Introduction: Ibuprofen disappeared from the pharmacy shelves during the 2019 coronavirus (COVID-19) pandemic. However, a while later, information circulated that ibuprofen should be avoided as it could worsen COVID-19 symptoms. The aim of our study was to assess the association of acute and chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) with worse COVID-19 outcomes. Methods: We did a prospective cohort study between April 12 and June 1, 2020. Adults consecutively diagnosed with COVID-19 were included. Information on NSAID use was collected through a telephone questionnaire, and patients were followed up for COVID-19 infection outcomes, including death, admission, severity, time to clinical improvement, oxygen requirement and length of stay. Results: Acute use of ibuprofen was not associated with a greater risk of mortality relative to non-use (adjusted hazard ratio [HR] 0.632 [95% CI 0.073-5.441; P = 0.6758]). Chronic NSAID use was also not associated with a greater risk of mortality (adjusted HR 0.492 [95% CI 0.178-1.362; P = 0.1721]). Acute ibuprofen use was not associated with a higher risk of admission compared to non-NSAID users (adjusted odds ratio OR 1.271; 95% CI 0.548-2.953). NSAID users did not have a significantly longer time to clinical improvement or length of stay. Conclusion: Acute or chronic use of ibuprofen and other NSAIDs was not associated with worse COVID-19 disease outcomes.
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