Home as the new frontier for the treatment of COVID-19: the case for anti-inflammatory agents

Determinants of early triage for hospitalization in myeloproliferative neoplasm (MPN) patients with COVID‐19

“… 4 It follows that the presence of elevated levels of NLR as a consequence of the marked reduction of lymphocyte counts and neutrophilia, should be considered a warning signal for a prompt therapy‐decision making with anti‐inflammatory and anti‐viral therapy, particularly in the presence of symptoms. Non‐steroidal‐anti‐inflammatory‐drugs (NSAIDs) have been recently suggested for the management of outpatients with early symptoms of COVID‐19 5 to mitigate hospitalization and infection severity. However, whether NSAIDs can provide a favorable risk–benefit profile in all MPN patients has not yet been explored and caution should be exerted in MPN patients who are constitutively prone to bleeding tendency.…”

Full-dose NSAIDs at the first sign of respiratory infection? – Authors’ reply

“…We appreciate the comments on our Review article 1 from Alberto Donzelli. We agree that inflammation plays an initial and defensive role in fighting infection.…”

Full-dose NSAIDs at the first sign of respiratory infection?

“…In their Review article in The Lancet Infectious Diseases , Norberto Perico and colleagues 1 recommend administration of non-steroidal anti-inflammatory drugs (NSAIDs) at the first sign of respiratory infection, without waiting for a confirmation of COVID-19. This recommendation contradicts both the ritual assertion that inflammation initially plays a defensive role against infections, and the results of two large randomised controlled trials showing an unfavourable and unsafe role of ibuprofen in managing respiratory infections.…”

“…The authors acknowledge the more convincing data available for indometacin, the only NSAID to be successfully tested in a randomised controlled trial (against paracetamol), 3 with in-vitro antiviral effects against several viruses and SARS-CoV-2, 1 and outperforming a matched group of celecoxib users in a real-world dataset. 4 Nevertheless, their recommended NSAIDs for early COVID-19 symptoms in adults include nimesulide, celecoxib (which has not been successfully tested in randomised controlled trials), ibuprofen (with unfavourable results in randomised controlled trials for respiratory infections), 2 and aspirin (for which an ineffective randomised controlled trial is cited, 1 which was associated with safety problems, as well as other uncited null randomised controlled trials), rather than indometacin.…”

“…Therefore, the authors correctly conclude that randomised controlled trials are required to consolidate their positive observational findings. 1 …”