Cyclooxygenase inhibitor use is associated with increased COVID-19 severity
Justin T Reese, Ben Coleman2, Lauren Chan3, Hannah Blau4, Tiffany J Callahan5, Luca Cappelletti7, Tommaso Fontana8, Katie Rebecca Bradwell9, Nomi L Harris1, Elena Casiraghi7, Giorgio Valentini7, Guy Karlebach4, Rachel Deer11, Julie A Mcmurry6, Melissa A Haendel6, Christopher G Chute12, Emily Pfaff13, Richard Moffitt14, Heidi Spratt11, Jasvinder Singh15, Christopher J Mungall1, Andrew E Williams17, Peter N Robinson
doi:10.1101/2021.04.13.21255438
BACKGROUND Cyclooxygenase (COX) inhibitors including non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community acquired pneumonia and other respiratory tract infections (RTIs). Conclusive data are not available about potential beneficial or adverse effects of COX inhibitors on COVID-19 patients.
METHODS We conducted a retrospective, multi-center observational study by leveraging the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative (N3C). Potential associations of eight COX inhibitors with COVID-19 severity were assessed using ordinal logistic regression (OLR) on treatment with the medication in question after matching by treatment propensity as predicted by age, race, ethnicity, gender, smoking status, comorbidities, and BMI. Cox proportional hazards analysis was used to estimate the correlation of medication use with morbidity for eight subcohorts defined by common indications for COX inhibitors.
RESULTS OLR revealed statistically significant associations between use of any of five COX inhibitors and increased severity of COVID-19. For instance, the odds ratio of aspirin use in the osteoarthritis cohort (n=2266 patients) was 3.25 (95% CI 2.76 -3.83). Aspirin and acetaminophen were associated with increased mortality.
CONCLUSIONS The association between use of COX inhibitors and COVID-19 severity was consistent across five COX inhibitors and multiple indication subcohorts. Our results align with earlier reports associating NSAID use with complications in RTI patients. Further research is needed to characterize the precise risk of individual COX inhibitors in COVID-19 patients. .
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