Non-steroidal anti-inflammatory drugs are common treatments for acute pain and rheumatological diseases, such as rheumatoid arthritis and osteoarthrosis.
Early in the pandemic, there was debate on whether the use of such drugs increased the severity of COVID-19, which led to urgent calls for investigations between these drugs and the infection with SARS-CoV-2 virus.
A new study, published in the journal The Lancet Rheumatology, tried to characterize the safety of non-steroidal anti-inflammatory drugs, and identify whether pre-existing use of these drugs was associated with increased severity of COVID-19 disease.
This prospective, multicenter cohort study, actively recruiting across England, Scotland, and Wales, included more than 72,000 patients of any age, admitted to hospital with a confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19.
The study collected data on the medication patients had been prescribed, were currently taking, or had taken within 14 days prior to being admitted to hospital, as well as demographic information, and medical history.
The primary outcome was in-hospital mortality. The secondary outcomes were disease severity at presentation, admission to critical care, requirement for invasive or non-invasive ventilation, use of supplemental oxygen, or development of acute kidney injury.
Of the 72,179 patients eligible for the study, 5.8% had taken non-steroidal anti-inflammatory drugs prior to admission.
In the study, around a third of patients who had taken non-steroidal anti-inflammatory drugs prior to hospital admission for COVID-19 died. A rate which was similar in patients who had not taken these drugs.
In patients with rheumatological disease, the use of non-steroidal anti-inflammatory drugs did not increase mortality.
Those who took non-steroidal anti-inflammatory drugs were no more likely to be admitted to critical care, need invasive or non-invasive ventilation, or require oxygen.
The authors noted some limitations of the study. Despite being the largest ongoing prospective study of patients admitted to hospital, it only represents 60% of hospitalized patients in the UK over the time of the study and it did not include patients with severe COVID-19 who were not hospitalized.
However, it would be expected that most patients who had severe COVID-19 would have been admitted to hospital and therefore included in the study, the authors said. The study did not determine whether patients continued to be given non-steroidal anti-inflammatory drugs while they were in hospital, so the authors cannot make any recommendations on this.
Additionally, the study could not capture how long patients were taking non-steroidal anti-inflammatory drugs prior to hospital admission and whether they were being taken for long-term conditions or short-term symptom relief.
In the UK, ibuprofen is the most commonly used non-steroidal anti-inflammatory drug, so it is unclear whether the results of this study are generalizable to other countries where other non-steroidal anti-inflammatory drugs are more frequently used.
Further analyses performed suggested other non-ibuprofen non-steroidal anti-inflammatory drugs had a similar safety profile to ibuprofen.
Future research and clinical trials may help definitively establish whether non-steroidal anti-inflammatory drugs are safe in different populations and whether their anti-inflammatory effects have any impact on patients with COVID-19.
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