Infectious Disease

No link between NSAIDs, severe COVID-19

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The researchers report support from the National Institute for Health Research (NIHR), the Medical Research Council, the NIHR Department of Health Protection Research (HPRU) for emerging and zoonotic infections at Liverpool University and the NIHR HPRU for respiratory infections at Imperial College London, NIHR Biomedical Research Center at Imperial College London and NIHR Clinical Research Network. Drake does not report any additional information. In the study you will find all relevant financial information from all other authors.

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According to data published in The Lancet Rheumatology, there is no association between the use of NSAIDs and the increased severity or mortality of COVID-19.

Studies in patients with non-SARS-CoV-2 respiratory infections have identified associations between NSAIDs (including cyclooxygenase) [COX]-2 inhibitors) and increased complication rates ” Thomas M. Drake, MBChB, of the Usher Institute at the University of Edinburgh in Great Britain and colleagues wrote. “These studies found that NSAID use was associated with higher rates of myocardial infarction, pleural empyema, and longer hospital stays. However, the results used in such pneumonia studies, such as empyema, are less common in patients with SARS-CoV-2 infection. “

According to Drake TM et al. There is no association between NSAID use and increased severity or mortality from COVID-19. Lancet Rheumatol. 2021; doi: 10.1016 / S2665-9913 (21) 00104-1.

“In preclinical models, there is evidence that NSAIDs reduce pulmonary edema, decrease endothelial leakage, and reduce the severity of acute respiratory distress syndrome (ARDS), suggesting that they may be useful in at least treating COVID-19. A clinical is currently ongoing Study, ”they added.

To analyze whether NSAID use is linked to increased severity of COVID-19, Drake and colleagues conducted a prospective multicenter cohort study of 78,674 patients in 255 healthcare facilities in England, Scotland and Wales. Participants included patients of all ages who were hospitalized between January 17, 2020 and August 10, 2020 with a confirmed or highly suspected SARS-CoV-2 infection that resulted in COVID-19. A total of 72,179 patients were available for reconciliation at death. This group enrolled 4,211 patients taking systemic NSAIDs prior to hospitalization.

The primary outcome was in-hospital mortality, while the secondary outcome was disease severity at presentation, admission to intensive care, maintenance of invasive ventilation, maintenance of non-invasive ventilation, use of supplemental oxygen, and acute kidney injury included. NSAID use had to be made within 2 weeks of hospitalization. Researchers used logistic regression to estimate the effects of NSAIDs to account for confusing variables, as well as propensity rating to further assess their effects and account for covariate differences in populations.

After the propensity score matching, Drake and colleagues compared two balanced groups of NSAID users and non-users with 4,205 patients each.

According to the researchers, there were no significant differences in severity between the two groups during hospital stays. After adjusting for explanatory variables, there was no association between the use of NSAIDs and poorer mortality in hospital (adjusted OR = 0.95; 95% CI, 0.84-1.07) and admission to intensive care (adjusted OR = 1.01; 95% CI, 0.87-1.17)), requirement for invasive ventilation (adjusted OR = 0.96; 95% CI, 0.80-1.17), requirement for non-invasive ventilation Ventilation (adjusted OR = 1.12; 95% CI, 0.96-1.32), requirement for oxygen (adjusted OR = 1); 95% CI, 0.89-1.12) or acute kidney injury (matching OR = 1.08; 95% CI, 0.92-1.26).

“For clinicians and patients, our results should reassure us that NSAIDs can be used as indicated in the community without increasing the severity of COVID-19,” wrote Drake and colleagues. “Our study did not measure whether NSAIDs were continued in the hospital. Therefore, we cannot make any recommendations as to whether these should be withheld or continued after admission to hospital.

“There are important groups of patients who rely on NSAIDs for pain relief, including those with inflammatory joint disease, bone pain, gout, post-operative pain, and menstrual pain who would otherwise have few non-opioid options for pain relief,” they added. “Taken together, doctors should continue to prescribe and administer NSAIDs the same way they did before the COVID-19 pandemic began.”

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