Risk of COVID-19 Diagnosis and Hospitalisation in Patients with Osteoarthritis or Back Pain Treated with Ibuprofen Compared to Other NSAIDs or Paracetamol: A Network Cohort Study
Junqing Xie, James T Brash, Cigdem Turkmen, Stefan Driessen, Giustino Varrassi, George Argyriou, Sarah Seager, Christian Reich, Daniel Prieto-Alhambra
Drugs, doi:10.1007/s40265-022-01822-z
Objective We aimed to investigate whether ibuprofen use, compared with other non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs), cyclooxygenase-2 inhibitors (COX-2i) or paracetamol, increases the risk of coronavirus disease 2019 (COVID-19) diagnosis or hospitalisation. Design A prevalent user and active comparator cohort study. Setting Two US claims databases (Open Claims and PharMetrics Plus) mapped to the Observational Medical Outcomes Partnership Common Data Model. Participants Insured patients with a history of osteoarthritis or back pain and receiving ibuprofen, other ns-NSAIDs, COX-2i or paracetamol between
or paracetamol, was not associated with an increased risk of susceptibility and severity of COVID-19.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s40265-022-01822-z.
Declarations Funding Abbott contracted IQVIA for the conduct of this study. Prof. Prieto-Alhambra receives funding from the UK National Institute for Health Research in the form of a Senior Research Fellowship, and as part of the Oxford National Institute for Health Research Biomedical Research Centre. Prof. Giustino Varrassi had a contract with Abbott International, as a consultant for scientific projects. He is also a consultant for scientific projects with Dompé Farmaceutici and Menarini Group. Ethics Approval These assets are de-identified, commercially available data products that could be purchased and licensed by any researcher. The collection and de-identification of these data assets is a process that is commercial intellectual property and not privileged to the data licensees and the co-authors on this study. Licensees of these data have signed data use agreements with the data vendors that detail the usage protocols for running retrospective research on these databases. All analyses performed in this study were in accordance with data use agreement terms as specified by the data owners. As these data are deemed commercial assets, there is no institutional review board applicable to the usage and dissemination of these result..
References
Au, Reed, Curtis, High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis, Ann Rheum Dis,
doi:10.1136/ard.2010.128637
Chandan, Zemedikun, Thayakaran, Nonsteroidal antiinflammatory drugs and susceptibility to COVID-19, Arthritis Rheumatol,
doi:10.1002/art.41593
Day, Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists, BMJ,
doi:10.1136/bmj.m1086
Drake, Fairfield, Pius, Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort: a matched, prospective cohort study, Lancet Rheumatol,
doi:10.1016/S2665-9913(21)00104-1
Esba, Alqahtani, Thomas, Shamas, Alswaidan et al., Ibuprofen and NSAID use in COVID-19 infected patients is not associated with worse outcomes: a prospective cohort study, Infect Dis Ther,
doi:10.1007/s40121-020-00363-w
Fang, Karakiulakis, Roth, Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?, Lancet Respir Med,
doi:10.1016/S2213-2600(20)30116-8
Fernandez-Gutierrez, Leon, Madrid, Hospital admissions in inflammatory rheumatic diseases during the peak of COVID-19 pandemic: incidence and role of disease-modifying agents, Ther Adv Musculoskelet Dis,
doi:10.1177/1759720X20962692
Hoffmann, Kleine-Weber, Schroeder, SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor, Cell,
doi:10.1016/j.cell.2020.02.052
Kow, Hasan, The risk of mortality in patients with COVID-19 with pre-diagnosis use of NSAIDs: a meta-analysis, Inflammopharmacology,
doi:10.1007/s10787-021-00810-1
Levy, Clish, Schmidt, Gronert, Serhan, Lipid mediator class switching during acute inflammation: signals in resolution, Nat Immunol,
doi:10.1038/89759
Monti, Montecucco, Non-steroidal anti-inflammatory treatment during COVID-19: friend or foe? Response to: 'Coronavirus disease 19 (Covid-19) and non-steroidal anti-inflammatory drugs (NSAID)' by Giollo et al, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-217638
Moore, Pollack, Butkerait, Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs, Ther Clin Risk Manag,
doi:10.2147/TCRM.S79135
Nice, COVID-19 rapid evidence summary: acute use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19
Ohdsi, OMOP Common Data Model
Park, Lee, You, Kim, Yang, Non-steroidal antiinflammatory agent use may not be associated with mortality of coronavirus disease 19, Sci Rep,
doi:10.1038/s41598-021-84539-5
Petersen, Porter, Gruber, Wang, Van Der Laan, Diagnosing and responding to violations in the positivity assumption, Stat Methods Med Res,
doi:10.1177/0962280210386207
Prats-Uribe, Sena, Lai, Use of repurposed and adjuvant drugs in hospital patients with COVID-19: multinational network cohort study, BMJ,
doi:10.1136/bmj.n1038
Prieto-Alhambra, Kostka, Duarte-Salles, Unraveling COVID-19: a large-scale characterization of 4.5 million COVID-19 cases using CHARYBDIS, Clin Epidemiol,
doi:10.2147/CLEP.S323292
Qiao, Wang, Chen, Ibuprofen attenuates cardiac fibrosis in streptozotocin-induced diabetic rats, Cardiology,
doi:10.1159/000375362
Roy, Coronavirus: alerte sur l'ibuprofène et autres anti-inflammatoires
Schuemie, Hripcsak, Ryan, Madigan, Suchard, Empirical confidence interval calibration for population-level effect estimation studies in observational healthcare data, Proc Natl Acad Sci,
doi:10.1073/pnas.1708282114
Schuemie, Hripcsak, Ryan, Madigan, Suchard, Robust empirical calibration of p-values using observational data, Stat Med,
doi:10.1002/sim.6977
Tian, Schuemie, Suchard, Evaluating large-scale propensity score performance through real-world and synthetic data experiments, Int J Epidemiol,
doi:10.1093/ije/dyy120
Torjesen, Covid-19: ibuprofen can be used for symptoms, says UK agency, but reasons for change in advice are unclear, BMJ,
doi:10.1136/bmj.m1555
Wong, Mackenna, Morton, Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-219517
Woodward, Formulae for sample size, power and minimum detectable relative risk in medical studies, J R Stat Soc D,
doi:10.2307/2348252