medwireNews: Nonsteroidal anti-inflammatory drug (NSAID) use is not associated with more severe disease among people admitted to hospital with COVID-19, including those with rheumatic diseases, show data from a large, prospective UK cohort study.
“For clinicians and patients, our findings should provide reassurance that NSAIDs can be used as indicated in the community without increasing the severity of COVID-19,” write Ewen Harrison (University of Edinburgh) and co-authors in The Lancet Rheumatology.
However, they note that the “study did not capture whether NSAIDs were continued in hospital, so we cannot make any recommendations on whether these should be withheld or continued after hospital admission.”
The prospective ISARIC Clinical Characterisation Protocol UK cohort study enrolled 78,674 patients of any age admitted to one of 255 health-care facilities in England, Scotland, and Wales with a confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 between January 17 and August 10, 2020. These individuals represented around 60% of all people admitted to a UK hospital with COVID-19 during that period.
Overall, 4211 (5.8%) patients were recorded as taking systemic NSAIDs within the 2 weeks before hospital admission, most commonly ibuprofen, followed by other NSAIDs (eg, diclofenac, ketorolac, naproxen, oxicams), and cyclooxygenase-2 inhibitors.
The researchers report that there were no significant differences in COVID-19 severity between NSAID users and nonusers at hospital admission and no significant difference in in-hospital mortality rates, at 30.4% and 31.3%, respectively.
After propensity score matching (4205 patients in each group) to account for covariate differences between the two groups, there was no significant difference between NSAID users and nonusers in rates of in-hospital mortality, critical care admission, requirement for invasive or noninvasive ventilation, requirement for oxygen, or acute kidney injury.
Furthermore, a sensitivity analysis including 7614 (10.5%) patients with rheumatic diseases showed that NSAID use was not significantly associated with increased mortality risk in these individuals.
There were also no significant differences in mortality rates by NSAID type in the whole cohort.
Harrison et al say: “There are important groups of patients who rely on NSAIDs for pain relief, including those with inflammatory joint diseases, bone pain, gout, postoperative pain, and menstrual pain, who would otherwise have few non-opioid options for pain relief.”
They believe that, based on their findings and those of others, “clinicians should continue to prescribe and manage NSAIDs in the same way as before the COVID-19 pandemic began.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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Lancet Rheumatol 2021; doi:10.1016/S2665-9913(21)00104-1