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0 0.5 1 1.5 2+ Mortality -18% Improvement Relative Risk Case -27% c19early.org/ace Chandan et al. Acetaminophen for COVID-19 Prophylaxis Is prophylaxis with acetaminophen+codeine or dihydrocodeine beneficial for COVID-19? PSM retrospective 17,190 patients in the United Kingdom (Jan - Jul 2020) Study compares with NSAIDs, results vs. placebo may differ More cases with acetaminophen+codeine or dihydrocodeine (not stat. sig., p=0.17) Chandan et al., Arthritis & Rheumatology, doi:10.1002/art.41593 Favors acetaminophen Favors NSAIDs
Nonsteroidal Antiinflammatory Drugs and Susceptibility to COVID-19
Chandan et al., Arthritis & Rheumatology, doi:10.1002/art.41593
Chandan et al., Nonsteroidal Antiinflammatory Drugs and Susceptibility to COVID-19, Arthritis & Rheumatology, doi:10.1002/art.41593
Apr 2021   Source   PDF  
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Retrospective 12,457 patients prescribed paracetamol with codeine/dihydrocodeine and 13,202 prescribed NSAIDs, showing no significant differences in cases and mortality. Patients prescribed codeine/dihydrocodeine may have different susceptibility to COVID-19.
risk of death, 17.6% higher, HR 1.18, p = 0.35, treatment 71 of 8,595 (0.8%), control 79 of 8,595 (0.9%), adjusted per study, inverted to make HR<1 favor treatment, propensity score matching, multivariable.
risk of case, 26.6% higher, HR 1.27, p = 0.17, treatment 8,595, control 8,595, adjusted per study, inverted to make HR<1 favor treatment, propensity score matching, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Chandan et al., 29 Apr 2021, retrospective, United Kingdom, peer-reviewed, mean age 65.4, 24 authors, study period 30 January, 2020 - 31 July, 2020, this trial compares with another treatment - results may be better when compared to placebo, this trial uses multiple treatments in the treatment arm (combined with codeine or dihydrocodeine) - results of individual treatments may vary.
Contact: k.nirantharan@bham.ac.uk, k.raza@bham.ac.uk.
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Abstract: Arthritis & Rheumatology Vol. 73, No. 5, May 2021, pp 731–739 DOI 10.1002/art.41593 © 2020 The Authors. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology. This is an open access article under the terms of the Creative Commons Attribution-­NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Nonsteroidal Antiinflammatory Drugs and Susceptibility to COVID-­19 Joht Singh Chandan,1 Dawit Tefra Zemedikun,2 Rasiah Thayakaran,2 Nathan Byne,3 Samir Dhalla,3 3 Dionisio Acosta-­Mena, Krishna M. Gokhale,2 Tom Thomas,4 Christopher Sainsbury,2 2 2 2 Anuradhaa Subramanian, Jennifer Cooper, Astha Anand, Kelvin O. Okoth,2 Jingya Wang,2 Nicola J. Adderley,2 Thomas Taverner,2 Alastair K. Denniston,5 Janet Lord,6 G. Neil Thomas,2 Christopher D. Buckley,7 Karim Raza,8 Neeraj Bhala,9 Krishnarajah Nirantharakumar,10 and Shamil Haroon2 Objective. To identify whether active use of nonsteroidal antiinflammatory drugs (NSAIDs) increases susceptibility to developing suspected or confirmed coronavirus disease 2019 (COVID-­19) compared to the use of other common analgesics. Methods. We performed a propensity score–­matched cohort study with active comparators, using a large UK primary care data set. The cohort consisted of adult patients age ≥18 years with osteoarthritis (OA) who were followed up from January 30 to July 31, 2020. Patients prescribed an NSAID (excluding topical preparations) were compared to those prescribed either co-­codamol (paracetamol and codeine) or co-­dydramol (paracetamol and dihydrocodeine). A total of 13,202 patients prescribed NSAIDs were identified, compared to 12,457 patients prescribed the comparator drugs. The primary outcome measure was the documentation of suspected or confirmed COVID-­ 19, and the secondary outcome measure was all-­cause mortality. Results. During follow-­up, the incidence rates of suspected/confirmed COVID-­19 were 15.4 and 19.9 per 1,000 person-­years in the NSAID-­exposed group and comparator group, respectively. Adjusted hazard ratios for suspected or confirmed COVID-19 among the unmatched and propensity score–matched OA cohorts, using data from clinical consultations in primary care settings, were 0.82 (95% confidence interval [95% CI] 0.62–­1.10) and 0.79 (95% CI 0.57–­1.11), respectively, and adjusted hazard ratios for the risk of all-cause mortality were 0.97 (95% CI 0.75–­1.27) and 0.85 (95% CI 0.61–­1.20), respectively. There was no effect modification by age or sex. Conclusion. No increase in the risk of suspected or confirmed COVID-­19 or mortality was observed among patients with OA in a primary care setting who were prescribed NSAIDs as compared to those who received comparator drugs. These results are reassuring and suggest that in the absence of acute illness, NSAIDs can be safely prescribed during the ongoing pandemic.
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