NSAID Use Not Linked to Increased Risk of Severe COVID-19

November 4, 2020

By Louise Gagnon

OTTAWA, Ontario -- November 3, 2020 -- Use of non-steroidal anti-inflammatory drugs (NSAIDs) does not appear to significantly increase the risk of critical coronavirus disease 2019 (COVID-19) illness, according to a study presented at the 2020 Virtual Meeting of the American College of Emergency Physicians (ACEP).

“We were interested in looking at what were the predictors of critical [COVID-19] illness,” said Sidney J. Perkins, University of Michigan Medical School, Ann Arbor, Michigan. “We were looking back at patients who had screened positive for COVID-19 and then seeing what percentage developed critical illness.”

“The motivation for doing the research was to have a higher level of evidence regarding the use of ibuprofen,” she explained. “These [NSAIDs] are useful medications for all sorts of different things. And to just wholesale say that you can’t use a medication and not have evidence behind that statement is not sound.”

The researchers conducted a retrospective analysis of 422 patients. The primary outcome was death, respiratory failure (intubation required), or shock within 28 days after presentation in the emergency department (ED).

Of the patients, 88 (21%) were on NSAIDs prior to becoming infected with COVID-19 and 89 (21%) developed severe COVID-19 within 28 days of ED presentation. Among those using NSAIDs, 18 (20%) developed critical illness.

Of the 11 predictive factors that were under consideration, hypertension (odds ratio [OR] = 1.04; 95% confidence interval [CI], 0.38-1.71; P = .0021), diabetes (OR = 0.97; 95% CI, 0.42-1.52; P = .0005), and chronic lung disease (OR = 1.20; 95% CI, 0.20-2.20; P = .0185) were significantly associated with increased risk of critical COVID-19 illness.

However, NSAID use was not significantly associated with critical illness (OR = 0.05; 95% CI, 0.57-0.73).

“This can be helpful information for doctors who really want to prescribe NSAIDs for a patient,” said Perkins.

A limitation of the investigation is that it was retrospective, pointed out Perkins, noting future investigations should confirm the use of NSAIDs with patients individually.

“I think that the best study would involve calling patients and asking if they were using NSAIDs before they were admitted to hospital,” said Perkins. “I think that is something that we could quantify.”

[Presentation title: Clinical Outcomes Among COVID-19 Patients Taking Non-Steroidal Anti-Inflammatory Drugs. Abstract 41]