- Evidence of possible harm was associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) in acute respiratory infections (ARI).1,2,3,4,5
- A review of case-control studies suggests higher rates of complications.2,3
- Observational studies suggest further increased risks of acute myocardial infarction and stroke, in addition to the risk associated with ARI itself.4,5
- Meanwhile NSAIDs are already known to cause nephrotoxicity.6,7
- Acute kidney injury (AKI) and chronic kidney disease (CDK) are associated with increased mortality in COVID-19 infection.8,9 Moreover, CDK is associated with enhanced risk of severe COVID-19.9
- Overall, despite those concerns, there’s no strong evidence against the use of NSAIDs specifically in patients with COVID-19.
Based on currently available information, the WHO does not recommend against the use of ibuprofen (March 18 2020). Authorities such as Health Canada, INESSS, FDA, European Medicines Agency and CDC agree that currently there is no reason to interrupt NSAIDs in patients who rely on them to treat chronic conditions.
These statements come from different sources in regards to concerns raised by an article in The Lancet (March 11 2020) about ibuprofen hypothetically capable of aggravating COVID-19 infection. The mechanism proposed was through the increased expression of angiotensin-converting enzyme II (ACE2), an enzyme needed by SARS-CoV and SARS-CoV-2 to bind to their target cells.10 However, no clinical trials have demonstrated this so far.
Other concerns raised by a review of case-control studies was the delayed resolving of inflammation in respiratory infections by NSAIDS. It was suggested that the inhibition of cyclooxygenases could reduce polymorphonuclear recruitment and also inhibits the synthesis of lipoxins and resolvins.1,3
- Little P (March27 2020). Non-steroidal anti-inflammatory drugs and covid-19. BMJ. https://doi.org/10.1136/bmj.m1185
- Basille D, Thomsen RW, Madsen M, et al (July 1 2018). Nonsteroidal anti-inflammatory drug use and clinical outcomes of community-acquired pneumonia. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.201802-0229LE
- Voiriot G, Dury S, Parrot A, et al. (February 2011). Nonsteroidal anti-inflammatory drugs may affect the presentation and course of community-acquired pneumonia. Chest. https://doi.org/10.1378/chest.09-3102
- Wen YC, Hsiao FY, Chan KA, et al (February 1 2017). Acute Respiratory Infection and Use of Nonsteroidal Anti-Inflammatory Drugs on Risk of Acute Myocardial Infarction: A Nationwide Case-Crossover Study. J Infect Dis. https://doi.org/10.1093/infdis/jiw603
- Wen YC, Hsiao FY, Lin ZF, et al (April 16 2018). Risk of stroke associated with use of nonsteroidal anti-inflammatory drugs during acute respiratory infection episode. Pharmacoepidemiology and drug safety. https://doi.org/10.1002/pds.4428
- Clavé S, Rousset-Rouvière C, Daniel L, Tsimaratos M. (December 17 2019). The invisible threat of non-steroidal anti-inflammatory drugs for kidneys. Front Pediatr. https://doi.org/10.3389/fped.2019.00520
- Zhang X, Donnan PT, Bell S, Guthrie B (August 1 2017). Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol. https://doi.org/10.1186/s12882-017-0673-8
- Cheng Y, Luo R, Wang K, Zhang M, et al (March 20, 2020). Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International. https://doi.org/10.1016/j.kint.2020.03.005
- Brandon M.H., Giuseppe L. (March 11, 2020). Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. International Urology and Nephrology (2020). https://doi.org/10.1007/s11255-020-02451-9
- Fang L, Karakiulakis G, Roth M (March 11 2020). Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet. https://doi.org/10.1016/S2213-2600(20)30116-8