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.
References
Agency, EMA gives advice on the use of nonsteroidal anti-inflammatories for COVID-19
Amici, Coro, Ciucci, Chiappa, Castilletti et al., Indomethacin has a potent antiviral activity against SARS coronavirus, Antiviral Therapy
Castro, Ross, Mcbride, Perlis, Identifying common pharmacotherapies associated with reduced COVID-19 morbidity using electronic health records,
doi:10.1101/2020.04.11.20061994
Chandler, Global ibuprofen shortage hits UK supermarkets-with shelves left empty
Clinicaltrials, Gov, Efficacy of addition of naproxen in the treatment of critically ill patients hospitalized for COVID-19 infection
Curhan, Bullock, Hankinson, Willett, Speizer et al., Frequency of use of acetaminophen, nonsteroidal anti-inflammatory drugs, and aspirin in US women, Pharmacoepidemiol Drug Saf
Drug, Usf, FDA advises patients on use of nonsteroidal anti-inflammatory drugs (NSAIDs) for COVID-19
Fang, Karakiulakis, Roth, Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?, Lancet Respir Med
Gov, Uk, COVID-19
Khan, Benthin, Zeno, Albertson, Boyd et al., A pilot clinical trial of recombinant human angiotensin-converting enzyme 2 in acute respiratory distress syndrome, Crit Care
Kuba, Imai, Rao, Gao, Guo et al., A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury, Nat Med
Lejal, Tarus, Bouguyon, Chenavas, Bertho et al., Structure-based discovery of the novel antiviral properties of naproxen against the nucleoprotein of influenza A virus, Antimicrob Agents Chemother
Liu, Yang, Zhang, Huang, Wang et al., Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury, Sci China Life Sci
Micallef, Soeiro, Ap, French Society of Pharmacology, Therapeutics (SFPT). Non-steroidal anti-inflammatory drugs, pharmacology and COVID-19 infection, Therapies,
doi:10.1016/j.therap.2020.05.003
News, Concerned about taking ibuprofen for coronavirus symptoms? Here's What Experts Say
News, Coronavirus and ibuprofen: separating fact from fiction
Paulose-Ram, Hirsch, Dillon, Gu, Frequent monthly use of selected non-prescription and prescription non-narcotic analgesics among US adults, Pharmacoepidemiol Drug Saf
Qiao, Wang, Chen, Zhang, Liu et al., Ibuprofen attenuates cardiac fibrosis in streptozotocin-induced diabetic rats, Cardiology
Safidahaj, Re, Response to the emerging novel coronavirus outbreak
Smart, Fawkes, Goggin, A narrative review of the potential pharmacological influence and safety of ibuprofen on coronavirus disease 19 (COVID-19), ACE2, and the immune system: a dichotomy of expectation and reality, Inflammopharmacol,
doi:10.1007/s10787-020-00745-z
Times, Managing and Treating Fever: A Guide to Nonprescription Antipyretics
Today, Fact check: does using ibuprofen when you have coronavirus make symptoms worse?
Wan, Shang, Graham, Baric, Li, Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus, J Virol,
doi:10.1128/JVI.00127-20
Wh, R&D Blueprint and COVID-19
Willsher, Anti-inflammatories may aggravate Covid-19
Yang, Gu, Zhao, Wang, Cao et al., Angiotensin-converting enzyme 2 (ACE2) mediates influenza H7N9 virus-induced acute lung injury, Sci Rep
Zheng, Zhang, Jiao, Shang, Cui, Naproxen exhibits broad anti-influenza virus activity in mice impeding viral nucleoprotein nuclear export, Cell Rep