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Systematic Review and Meta-analysis of the NSAID and COVID-19 Studies: June 2021
In this review, Professor Nicholas Moore and a team of researchers conducted a review and meta-analysis of publications mentioning the use of NSAIDs and COVID-19 outcomes, and concur with regulatory agencies, scientific societies and the World Health Organization that there is no evidence that NSAIDs caused an increased risk of developing COVID-19 or a more severe case of COVID-19. In fact, there is evidence that it does not cause an increased risk. A regulatory decision based on anecdotal reports and irrelevant experimental data may well have deprived patients of an effective drug to control pain and fever.
Moore N, Bosco-Levy P, Thurin N, Blin B, Droz-Perroteau C. Drug Safety 2021 44:929-938. Published 2 August 2021. doi.org/10.1007/s40264-021-01089-5
PLOS Medicine Study: September 8, 2020
In this study of 9,236 Danish residents who tested positive for COVID-19 between February 27th and April 29th, 2020, the use of NSAIDs [like ibuprofen] within 30 days of the positive test was not associated with an increased risk of hospitalization, ICU admission, mechanical ventilation, renal replacement therapy or mortality.
Lund LC, Kristensen KB, Reilev M, et al. PLoS Med. 2020;17(9):e1003308. Published 2020 Sep 8. doi:10.1371/journal.pmed.1003308
Journal of Clinical Medicine Study: August 10, 2020
“This [multicentre, prospective, observational study of 1,222 adult patients hospitalised with COVID-19 in eight UK hospitals] found no evidence that routine NSAID use was associated with higher COVID-19 mortality… therefore, patients should be advised to continue taking these medications until further evidence emerges.”
Bruce E, Barlow-Pay F, Short R, Vilches-Moraga A, Price A, McGovern A, Braude P, Stechman M, Moug S, McCarthy K, Hewitt J, Carter B, Myint P. J Clin Med. 2020 Aug 10;9(8):E2586.
Clinical Microbiology and Infection Study: June 12, 2020
“In this [retrospective cohort study of 403 patients with COVID-19 from Shamir Medical Centre, Israel] ibuprofen use was not associated with worse clinical outcomes, compared with paracetamol [acetaminophen]. In patients with fever, there was no difference in clinical outcomes between ibuprofen and paracetamol [acetaminophen] users.”
Rinott E, Kozer E, Shapira Y, Bar-Haim A, Youngster I. Clin Microbial Infect, 2020 Jun 12; S1198-743X(20)30343-8.
Chest Study in Vancouver, BC, Canada: March 2020
An early study in Vancouver, BC, Canada, concluded that the current epidemiologic evidence is not strong enough to infer a causal link of a harmful effect of ibuprofen in patients with COVID-19, and we need to be cautious when drawing conclusions from evidence that is derived from mechanistic or theoretical pharmacology, as they are not always corroborated with data from clinical trials.
Sodhi M, Etminan M. Safety of Ibuprofen in Patients With COVID-19: Causal or Confounded?. Chest. 2020;158(1):55-56. doi:10.1016/j.chest.2020.03.040]
American Headache Society, July 2020
A recent study, published in Headache in July 2020, concluded that there is no specific evidence at this time against the use of NSAIDs in patients with or without COVID‐19. Authors recommend a patient should be assessed for any other chronic diseases, underlying or pre-existing illnesses or conditions (i.e., co-morbid medical conditions) that may limit the use of NSAIDs and recommend a discussion of risks and benefits with all patients prior to prescribing NSAIDs.
Arca KN, Smith JH, Chiang CC, et al. COVID-19 and Headache Medicine: A Narrative Review of Non-Steroidal Anti-Inflammatory Drug (NSAID) and Corticosteroid Use [published online ahead of print, 2020 Jul 10]. Headache. 2020;10.1111/head.13903. doi:10.1111/head.13903]
Clinical Infectious Disease Study: July 27, 2020
An observational study from South Korea suggested that the harms associated with NSAID use may outweigh their benefits for patients with COVID-19; however, researchers looked only at patients hospitalized with COVID-19 who were prescribed prescription-strength, not OTC NSAIDs, and it is unclear if the prescribed NSAIDs were part of their COVID-19 treatment course or for one or more underlying serious health conditions.
Jeong HE, Lee H, Shin HJ, Choe YJ, Filion KB, Shin JY. Clin Infect Dis. 2020 Jul 27:ciaa1056. doi: 10.1093/cid/ciaa1056. Epub ahead of print. PMID: 32717066; PMCID: PMC7454423.