UK Study Confirms NSAIDS Do Not Result in Worse COVID-19 Outcomes

Dawn O'Shea

May 11, 2021

The use of non-steroidal anti-inflammatory drugs (NSAIDs) does not lead to higher rates of death or severe disease in patients who are hospitalised with COVID-19, according to a new observational study of more than 72,000 people in the UK published in the Lancet Rheumatology journal.

The ISARIC CCP-UK (International Severe Acute Respiratory and emerging Infection Consortium Clinical Characterisation Protocol United Kingdom) study, which is the largest of its kind, provides clear evidence that the continued use of NSAIDs in patients with COVID-19 is safe.

In the study, around a third of patients (30.4%; 1279 out of 4211) who had taken NSAIDs prior to hospital admission for COVID-19 died, a rate which was similar (31.3%; 21,256 out of 67,968) in patients who had not taken NSAIDs. In patients with rheumatological disease, the use of NSAIDs did not increase mortality.

The prospective, multicentre cohort study, published in the Lancet Rheumatology, included patients of any age admitted to the hospital with a confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 between 17 January and 10 August 2020.

The primary outcome was in-hospital mortality, and secondary outcomes were disease severity at presentation, admission to critical care, receipt of invasive ventilation, receipt of non-invasive ventilation, use of supplementary oxygen and acute kidney injury. NSAID use was required to be within the two weeks before hospital admission.

A total of 78,674 patients were enrolled across 255 health care facilities in England, Scotland and Wales. Of these, 72,179 patients had death outcomes available for matching.

In this cohort, 4211 (5.8%) patients were recorded as taking systemic NSAIDs before admission to hospital. Following propensity-score matching, balanced groups of NSAID users and non-users were obtained (4205 patients in each group).

At hospital admission, there was no significant difference in severity between exposure groups. After adjusting for explanatory variables, NSAID use was not associated with worse in-hospital mortality (matched OR, 0.95; 95% CI, 0.84-1.07; P=.35), critical care admission (matched OR, 1.01; 95% CI, 0.87-1.17; P=.89), requirement for invasive ventilation (matched OR, 0.96; 95% CI, 0.80-1.17; P=.69), requirement for non-invasive ventilation (matched OR, 1.12; 95% CI, 0.96-1.32; P=.14), requirement for oxygen (matched OR, 1.00; 95% CI, 0.89-1.12; P=.97) or occurrence of acute kidney injury (matched OR, 1.08; 95% CI, 0.92-1.26; P=.33).

Prof Ewen Harrison, of the University of Edinburgh and lead author of the study, said: "When the pandemic began over a year ago, we needed to be sure that these common medications would not lead to worse outcomes in people with COVID-19. We now have clear evidence that NSAIDs are safe to use in patients with COVID-19, which should provide reassurance to both clinicians and patients that they can continue to be used in the same way as before the pandemic began."

The authors say policymakers should consider reviewing issued advice around NSAID prescribing and COVID-19 severity.

References:

Drake TM, Fairfield CJ, Pius R, Knight SR, Norman L, Girvan M, Hardwick HE, Docherty AB, Thwaites RS, Openshaw PJM, Baillie JK, Harrison EM, Semple MG; for the ISARIC4C Investigators. Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort: a matched, prospective cohort study. Lancet Rheumatol. 2021 May 7 [Epub ahead of print]. doi: 10.1016/S2665-9913(21)00104-1.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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