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Evaluating NSAIDs in SARS-CoV-2: Immunomodulatory mechanisms and future therapeutic strategies

Moshawih et al., Heliyon, doi:10.1016/j.heliyon.2024.e25734
Feb 2024  
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Review of NSAIDs and their complex immunomodulatory roles in SARS-CoV-2 infection. Authors discuss the mechanisms by which NSAIDs impact viral replication, immune responses, and inflammation. They note NSAIDs can reduce neutrophil recruitment and cytokine release but also potentially compromise antiviral innate immune cell activity. Specific NSAIDs demonstrate antiviral effects by increasing nitric oxide and inhibiting COX enzymes. NSAIDs also modulate cytokine storm and boost anti-tumor immunity by inhibiting COX-2/PGE2 signaling. Furthermore, NSAIDs influence the p38 MAPK pathway, which is implicated in SARS-CoV-2 inflammation. Authors emphasize that the dual nature of NSAIDs warrants caution, especially in vulnerable groups.
See Day et al. for another review covering ibuprofen for COVID-19.
Review covers ibuprofen and indomethacin.
Moshawih et al., 2 Feb 2024, peer-reviewed, 6 authors. Contact:
This PaperIbuprofenAll
Evaluating NSAIDs in SARS-CoV-2: Immunomodulatory mechanisms and future therapeutic strategies
Said Moshawih, Qais Jarrar, Abdul Alim Bahrin, Ai Fern Lim, Long Ming, Hui Poh Goh
Heliyon, doi:10.1016/j.heliyon.2024.e25734
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely recognized for their analgesic and anti-inflammatory properties. Amidst the SARS-CoV-2 pandemic, the role of NSAIDs in modulating viral and bacterial infections has become a critical area of research, sparking debates and necessitating a thorough review. This review examines the multifaceted interactions between NSAIDs, immune responses, and infections. Focusing on the immunomodulatory mechanisms of NSAIDs in SARS-CoV-2 and their implications for other viral and bacterial infections, we aim to provide clarity and direction for future therapeutic strategies. NSAIDs demonstrate a dual role in infectious diseases. They reduce inflammation by decreasing neutrophil recruitment and cytokine release, yet potentially compromise antiviral defense mechanisms. They also modulate cytokine storms in SARS-CoV-2 and exhibit the potential to enhance anti-tumor immunity by inhibiting tumor-induced COX-2/PGE2 signaling. Specific NSAIDs have shown efficacy in inhibiting viral replication. The review highlights NSAIDs' synergy with other medications, like COX inhibitors and immunotherapy agents, in augmenting therapeutic effects. Notably, the World Health Organization's analysis found no substantial link between NSAIDs and the worsening of viral respiratory infections. The findings underscore NSAIDs' complex role in infection management. Understanding these interactions is crucial for optimizing therapeutic approaches in current and future pandemics. However, their dual nature warrants cautious application, particularly in vulnerable populations. NSAIDs present a paradoxical impact on immune responses in viral and bacterial infections. While offering potential benefits, their usage in infectious diseases, especially SARS-CoV-2, demands a nuanced understanding to balance therapeutic advantages against possible adverse effects.
Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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