Non-steroidal anti-inflammatory agent use may not be associated with mortality of coronavirus disease 19
Park et al.
, Non-steroidal anti-inflammatory agent use may not be associated with mortality of coronavirus disease 19
, Scientific Reports, doi:10.1038/s41598-021-84539-5
Retrospective 2,365 patients prescribed acetaminophen and 398 prescribed NSAIDs in South Korea, showing no significant differences.
risk of death, 24.8% lower, HR 0.75, p = 0.46, treatment 12 of 397 (3.0%), control 16 of 397 (4.0%), NNT 99, inverted to make HR<1 favor treatment, propensity score matching.
risk of mechanical ventilation, 37.5% lower, HR 0.62, p = 0.42, treatment 5 of 397 (1.3%), control 8 of 397 (2.0%), NNT 132, inverted to make HR<1 favor treatment, propensity score matching.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Park et al., 3 Mar 2021, retrospective, South Korea, peer-reviewed, 5 authors, this trial compares with another treatment - results may be better when compared to placebo.
agent use may not be associated
with mortality of coronavirus
Jungchan Park1, Seung‑Hwa Lee2,6*, Seng Chan You3, Jinseob Kim4 & Kwangmo Yang5,6*
Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used in patients with respiratory
infection, but their safety in coronavirus disease 19 (Covid-19) patients has not been fully investigated.
We evaluated an association between NSAID use and outcomes of Covid-19. This study was a
retrospective observational cohort study based on insurance benefit claims sent to the Health
Insurance Review and Assessment Service of Korea by May 15, 2020. These claims comprised all
Covid-19-tested cases and history of medical service use for the past 3 years in these patients. The
primary outcome was all-cause mortality, and the secondary outcome was need for ventilator care.
Among 7590 patients diagnosed with Covid-19, two distinct cohorts were generated based on NSAID
or acetaminophen prescription within 2 weeks before Covid-19 diagnosis. A total of 398 patients
was prescribed NSAIDs, and 2365 patients were prescribed acetaminophen. After propensity score
matching, 397 pairs of data set were generated, and all-cause mortality of the NSAIDs group showed
no significant difference compared with the acetaminophen group (4.0% vs. 3.0%; hazard ratio [HR],
1.33; 95% confidence interval [CI], 0.63–2.88; P = 0.46). The rate of ventilator care also did not show
significantly different results between the two groups (2.0% vs. 1.3%; HR, 1.60; 95% CI 0.53–5.30;
P = 0.42). Use of NSAIDs was not associated with mortality or ventilator care in Covid-19 patients.
NSAIDs may be safely used to relieve symptoms in patients with suspicion of Covid-19.
In December 2019, a major outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) in Wuhan
City, China, was first reported. It was later characterized as coronavirus disease 19 (Covid-19) and has become a
global threatening disease with more than 6,000,000 confirmed cases worldwide as of June 20201. By then, more
than 11,629 cases of Covid-19 had been diagnosed, and 273 deaths had been reported throughout Korea. Based
on this, the government of Korea decided to share the world’s first de-identified Covid-19 nationwide patient
data collected from the Korean National Health Insurance System for the purpose of investigation.
The primary site of infection in Covid-19 is the respiratory system. However, epidemiologic reports indicated
that mortality of Covid-19 was much higher in patients with cardiovascular disease2, and the most serious complications of Covid-19 are those involving cardiovascular and respiratory systems, as well as s epsis3,4. Non-steroidal anti-inflammatory drugs (NSAIDs) have long been widely used for symptomatic relief of infected patients
by controlling pain, fever, and inflammation, although safety concerns remain regarding harmful effects on the
cardiovascular system5. Moreover, NSAID treatment was associated with pulmonary complication in patients
with pneumonia6. The association between NSAID use and adverse outcome of Covid-19 has been previously
evaluated, but limited data have been reported7–9. In this study, we used de-identified Covid-19 nationwide data
from Korea to investigate the association between NSAID use to relieve symptoms before confirmed diagnosis
Department of Anesthesiology and Pain Medicine, Samsung Medical Center,..
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