NSAIDs Don't Worsen COVID 19 Outcomes, Study resolves controversy

NSAIDs provide effective analgesia and are important in the treatment of inflammatory diseases, particularly in those with the rheumatological disease, and are widely available as over the counter medications. More recent studies have found no associations between NSAID use, admission to hospital, and worse outcomes for patients with COVID-19. To further investigate, Prof Ewen M Harrison and his team conducted a study to characterise the safety of NSAIDs and evaluated whether pre-existing NSAID use was associated with increased severity of COVID-19 disease.

It was a prospective, multicentre cohort study of patients admitted to the hospital with a confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 between Jan 17 and Aug 10, 2020. The researchers included a total of 78 674 patients across 255 healthcare facilities in England, Scotland, and Wales among which, 72 179 patients had death outcomes available for matching. The major outcome assessed 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. They used logistic regression to estimate the effects of NSAIDs and adjust for confounding variables and, propensity score matching to further estimate effects of NSAIDS while accounting for covariate differences in populations.

Key findings of the study were:

• In this study cohort, 4211 (5·8%) patients were taking systemic NSAIDs before admission to the hospital.
• After propensity score matching, the researchers obtained balanced groups of NSAIDs users and NSAIDs non-users (4205 patients in each group).
• During hospital admission, the researchers observed no significant differences in severity between exposure groups.
• Similarly, after adjusting for explanatory variables, they found no significant difference with NSAIDs use and

◊ Worse in-hospital mortality (matched or 0·95),

◊ Critical care admission (1·01),

◊ Requirement for invasive ventilation (0·96),

◊ Requirement for non-invasive ventilation (1·12),

◊ Requirement for oxygen (1·00), or

◊ Occurrence of acute kidney injury (1·08).

The authors concluded, "NSAID use is not associated with higher mortality or increased severity of COVID-19. Policymakers should consider reviewing issued advice around NSAID prescribing and COVID-19 severity."

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DOI: https://doi.org/10.1016/S2665-9913(21)00104-1