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0 0.5 1 1.5 2+ Mortality -23% Improvement Relative Risk Mortality (b) 17% c19early.org/ib Wong et al. Ibuprofen for COVID-19 Prophylaxis Favors ibuprofen Favors control
Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts
Wong et al., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-219517
Wong et al., Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis.., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-219517
Jan 2021   Source   PDF  
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Retrospective 2,463,707 people in the UK, showing no significant difference in COVID-19 mortality with NSAID use. Current NSAID users were defined as those ever prescribed an NSAID in the 4 months prior to study start, and non-users were those with no record of NSAID prescription in the same time period.
risk of death, 23.0% higher, HR 1.23, p = 0.19, adjusted per study, general population, multivariable.
risk of death, 17.0% lower, HR 0.83, p = 0.37, adjusted per study, rheumatoid arthritis/osteoarthritis patients, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Wong et al., 21 Jan 2021, retrospective, United Kingdom, peer-reviewed, median age 53.0, 32 authors, study period 1 March, 2020 - 14 June, 2020.
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Abstract: CLINICAL SCIENCE Use of non-­steroidal anti-­inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts Angel YS Wong ‍ ‍,1 Brian MacKenna,2 Caroline E Morton,2 Anna Schultze,1 Alex J Walker,2 Krishnan Bhaskaran,1 Jeremy P Brown,1 Christopher T Rentsch,1 Elizabeth Williamson,1 Henry Drysdale,2 Richard Croker,2 Seb Bacon,2 William Hulme,2 Chris Bates,3 Helen J Curtis,2 Amir Mehrkar,2 David Evans,2 Peter Inglesby,2 Jonathan Cockburn,3 Helen I McDonald,1 Laurie Tomlinson,1 Rohini Mathur,1 Kevin Wing,1 Harriet Forbes,1 Rosalind M Eggo,1 John Parry,3 Frank Hester,3 Sam Harper,3 Stephen JW Evans,1 Liam Smeeth,1 Ian J Douglas,1 Ben Goldacre,2 The OpenSAFELY Collaborative Handling editor Josef S Smolen ►► Additional material is published online only. To view, please visit the journal online (http://d​ x.​doi.o​ rg/​10.​1136/​ annrheumdis-​2020-​219517). 1 Department of Non-­ Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK 2 The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK 3 TPP, Leeds, UK Correspondence to Dr Angel YS Wong, London School of Hygiene & Tropical Medicine, London, UK; a​ ngel.​wong@l​ shtm.​ac.​uk AYW, BM and CEM contributed equally. Received 16 November 2020 Revised 8 January 2021 Accepted 8 January 2021 Published Online First 21 January 2021 ABSTRACT Objectives To assess the association between routinely prescribed non-­steroidal anti-­inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform. Methods We conducted two cohort studies from 1 March to 14 June 2020. Working on behalf of National Health Service England, we used routine clinical data in England linked to death data. In study 1, we identified people with an NSAID prescription in the last 3 years from the general population. In study 2, we identified people with rheumatoid arthritis/osteoarthritis. We defined exposure as current NSAID prescription within the 4 months before 1 March 2020. We used Cox regression to estimate HRs for COVID-19 related death in people currently prescribed NSAIDs, compared with those not currently prescribed NSAIDs, accounting for age, sex, comorbidities, other medications and geographical region. Results In study 1, we included 536 423 current NSAID users and 1 927 284 non-­users in the general population. We observed no evidence of difference in risk of COVID-19 related death associated with current use (HR 0.96, 95% CI 0.80 to 1.14) in the multivariable-­adjusted model. In study 2, we included 1 708 781 people with rheumatoid arthritis/osteoarthritis, of whom 175 495 (10%) were current NSAID users. In the multivariable-­adjusted model, we observed a lower risk of COVID-19 related death (HR 0.78, 95% CI 0.64 to 0.94) associated with current use of NSAID versus non-­use. Conclusions We found no evidence of a harmful effect of routinely prescribed NSAIDs on COVID-19 related deaths. Risks of COVID-19 do not need to influence decisions about the routine therapeutic use of NSAIDs. © Author(s) (or their employer(s)) 2021. Re-­use permitted under CC BY. Published by BMJ.
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