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24-11-2020 | COVID-19 | News

NSAIDs unlikely to increase COVID-19 susceptibility in people with osteoarthritis

Hannah Kitt

medwireNews: Among patients with osteoarthritis, the risk for COVID-19 is not increased with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) versus comparator analgesics, study findings indicate.

“These results are reassuring and suggest that in the absence of acute illness, NSAIDs can be safely prescribed during the ongoing pandemic,” say Krishnarajah Nirantharakumar (University of Birmingham, UK) and colleagues.

They analyzed data for 25,659 osteoarthritis patients from the UK THIN database, 13,202 of whom were prescribed oral NSAIDs (such as ibuprofen, naproxen, and diclofenac). The remaining 12,457 were prescribed co-codamol (acetaminophen and codeine) or co-dydramol (acetaminophen and dihydrocodeine), neither of which, unlike NSAIDs, have been “implicated in increasing susceptibility to COVID-19 susceptibility,” note the researchers.

As reported in Arthritis & Rheumatology, the rates of confirmed or suspected COVID-19 during the follow-up period (January–July 2020) did not differ significantly between patients who had been taking NSAIDs versus the alternative analgesics, with crude incidence rates of 15.4 and 19.9 per 1000 person–years, respectively. This gave a nonsignificant hazard ratio (HR) of 0.82, after adjusting for various factors including known COVID-19 risk factors.

The crude all-cause mortality rates were lower in the NSAID than the comparator group, at 14.0 and 34.6 per 1000 person–years, respectively, but there was no significant between-group difference after adjusting for confounders (HR=0.97).

These findings were reinforced in a propensity score-matched analysis consisting of 8595 individuals in each group. The incidence rates of COVID-19 were a comparable 14.8 and 17.9 per 1000 person–years among patients given NSAIDs or the comparator analgesics (adjusted HR=0.79), respectively, and the corresponding all-cause mortality rates were 18.5 and 16.6 per 1000 person–years (adjusted HR=0.85).

“Reassuringly, we also found no significant difference in the association between NSAID use and risk of COVID-19 and mortality in older compared to younger patients,” which “is important because older patients are at a substantially higher risk of developing COVID-19 and have a poorer prognosis,” comment the researchers.

“These results are also reassuring given the high prevalence of NSAID use in this age group.”

Nirantharakumar et al caution that these “findings will need to be confirmed in other cohorts as we restricted our analysis to those with pre-existing osteoarthritis to reduce the risk of confounding by indication and immortal time bias.”

And they conclude: “Further research is needed to investigate whether use of NSAIDs is associated with adverse outcomes from COVID-19 in those with confirmed SARS-CoV-2 infection and whether risks differ by type and dose of NSAID.”

The team adds that the ongoing LIBERATE trial “comparing lipid ibuprofen versus standard care for acute hypoxemic respiratory failure due to COVID-19 […] will help inform whether NSAIDs could be of benefit in the management of severe COVID-19.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

24 November 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Arthritis Rheumatol 2020; doi:10.1002/art.41593

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