Prevalence of NSAID use among people with COVID‐19 and the association with COVID‐19‐related outcomes: Systematic review and meta‐analysis

Abstract

Aim Recent reports of potential harmful effects of nonsteroidal anti‐inflammatory drugs (NSAIDs) in treating patients with coronavirus disease 2019 (COVID‐19) have raised great concern. Methods We searched the PubMed, EMBASE, Cochrane Library and MedRxiv databases to examine the prevalence of NSAID use and associated COVID‐19 risk, outcomes and safety. Results Twenty‐five studies with a total of 101 215 COVID‐19 patients were included. Prevalence of NSAID use among COVID‐19 patients was 19% (95% confidence interval [CI] 14‐23%, no. of studies [n] = 22) and NSAID use prior to admission or diagnosis of COVID‐19 was not associated with an increased risk of COVID‐19 (adjusted odds ratio [aOR] = 0.93, 95% CI 0.82‐1.06, I 2 = 34%, n = 3), hospitalization (aOR = 1.06, 95% CI 0.76‐1.48, I 2 = 81%, n = 5), mechanical ventilation (aOR = 0.71, 95% CI 0.47‐1.06, I 2 = 38%, n = 4) or length of hospital stay. Moreover, prior use of NSAIDs was associated with a decreased risk of severe COVID‐19 (aOR = 0.79, 95% CI 0.71‐0.89, I 2 = 0%, n = 7) and death (aOR = 0.68, 95% CI 0.52‐0.89, I 2 = 85%, n = 10). Prior NSAID administration might also be associated with an increased risk of stroke (aOR = 2.32, 95% CI 1.04‐5.2, I 2 = 0%, n = 2), but not myocardial infarction (aOR = 1.49, 95% CI 0.25‐8.92, I 2 = 0, n = 2) and composite thrombotic events (aOR = 1.56, 95% CI 0.66‐3.69, I 2 = 52%, n = 2). Conclusion Based on current evidence, NSAID use prior to admission or diagnosis of COVID‐19 was not linked with increased odds or exacerbation of COVID‐19. NSAIDs might provide a survival benefit, although they might potentially increase the risk of stroke. Controlled trials are still required to further assess the clinical benefit and safety (e.g., stroke and acute renal failure) of NSAIDs in treating patients with COVID‐19.

Effect of the chronic medication use on outcome measures of hospitalized COVID-19 patients: Evidence from big data

“…Furthermore, Piroxicam was associated with a 14% less risk of ventilation therapy and a 12% less mortality due to COVID-19. Currently, there seems to be no evidence suggesting that clinicians should refrain from or discontinue NSAIDs in patients with COVID-19 upon proper indication (32).…”

Myocarditis and Pericarditis Following the SARS-CoV-2 Infection and COVID-19 Vaccination

“…For pericardial involvement in the settings of SARS-CoV-2 infection, apart from its beneficial role in preventing relapses, colchicine seems to be specifically beneficial due to its anti-inflammatory and anti-cytokine [78,79]. Although NSAIDs may be beneficial in reducing the risk of severe COVID-19, they also can be harmful in COVID-19, as they may increase the risk of stroke but not myocardial infarction [80]. Despite their favored anti-inflammatory effects in the settings of SARS-CoV-2 infection, corticosteroids have been demonstrated to promote pericarditis relapse possibly.…”

Strategies Tackling Viral Replication and Inflammatory Pathways as Early Pharmacological Treatment for SARS-CoV-2 Infection: Any Potential Role for Ketoprofen Lysine Salt?

“…An optimal NSAID should give relief and prevent complications and worsening of the disease. Ketoprofen is a NSAID belonging to the family of propionic derivates, with analgesic, anti-inflammatory, antipyretic, and antiplatelet properties [76,77].…”