The use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, does not lead to higher rates of death or serious illness in patients hospitalized with COVID-19, according to a new observational study of over 72,000 people in the UK published in The Lancet Rhumatologie journal.
NSAIDs are common treatments for acute pain and rheumatic diseases such as rheumatoid arthritis and osteoarthritis. At the start of the pandemic, there was a debate over whether the use of these drugs increased the severity of COVID-19, which led to urgent calls for investigations between NSAIDs and COVID- 19.
The ISARIC CCP-UK (International Severe Acute Respiratory and Emerging Infection Consortium Clinical Characterization Protocol United Kingdom) study, which is the largest of its kind, provides clear evidence that the continued use of NSAIDs in patients with COVID-19 is sure.
In the study, about one-third of patients (30.4%. 1,279 of 4,211) who had taken NSAIDs prior to their hospitalization for COVID-19 died, a similar rate (31.3%. 21,256 of 67 968) in patients who had not taken NSAIDs. In patients with rheumatologic disease, the use of NSAIDs did not increase mortality.
Professor Ewen Harrison, University of Edinburgh and lead author of the study, said: “NSAIDs are commonly used to treat people all over the world for a range of conditions, from minor pain to chronic illnesses such as as arthritis and cardiovascular disease. . Many people rely on them to be able to carry out their daily activities. When the pandemic started over a year ago, we needed to make sure that these common drugs did not lead to worse outcomes in people with COVID-19. We now have clear evidence that NSAIDs are safe to use in patients with COVID-19, which should reassure both clinicians and patients that they can continue to be used in the same way as before. start of the pandemic. ”
The study collected data on medications that patients were prescribed, currently taking, or had taken in the 14 days prior to hospital admission, as well as demographic information and medical history. The study cohort included patients with confirmed or highly suspected COVID-19 infection admitted to 255 healthcare facilities in England, Scotland and Wales between January and August 2020. Of the 72,179 patients eligible for in the study, 5.8% (4,211) had taken NSAIDs. before admission
Modeling analyzes were used to estimate the effects of NSAIDs taken before hospitalization on hospital mortality rates, disease severity, ICU admission, need for invasive ventilation or not. invasive, supplemental oxygen use or the development of acute kidney injury, which were then compared to patients who did not take NSAIDs. Those taking NSAIDs were no more likely to be admitted to intensive care, to need invasive or non-invasive ventilation, or to need oxygen.
The authors noted some limitations to the study. Although this is the largest ongoing prospective study of patients admitted to hospital, it represents only 60% of patients hospitalized in the UK during the study period and did not include patients with severe COVID-19 who were not hospitalized. However, most of the patients with severe COVID-19 would be expected to have been hospitalized and therefore included in the study, the authors said. The study did not determine whether patients continued to receive NSAIDs during their hospital stay, so the authors cannot make any recommendation on this.
Additionally, the study could not capture how long patients took NSAIDs before they were admitted to hospital and whether they were taken for long-term conditions or for short-term symptom relief. In the UK, ibuprofen is the most commonly used NSAID, so it is unclear whether the results of this study can be generalized to other countries where other NSAIDs are more frequently used. Further analysis suggested that other non-ibuprofen NSAIDs had a safety profile similar to that of ibuprofen. Further research and clinical trials can help definitively establish whether NSAIDs are safe in different populations and whether their anti-inflammatory effects impact patients with COVID-19.
Thomas M Drake et al, Use of nonsteroidal anti-inflammatory drugs and results of COVID-19 in the British cohort of the ISARIC clinical characterization protocol: a prospective paired cohort study, The Lancet Rhumatologie (2021). DOI: 10.1016 / S2665-9913 (21) 00104-1
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