Edinburgh, UK—A large study involving more than 72,000 COVID-19 patients tries to put to rest, once and for all, concerns that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) raises the risk of a more severe case or death.

The report in The Lancet Rheumatology journal points out that, early in the pandemic, debate raged on whether NSAIDs, common treatments for acute pain and rheumatological diseases such as rheumatoid arthritis and osteoarthrosis, increased the severity of COVID-19.

University of Edinburgh–led authors said their effort, The ISARIC CCP-UK (International Severe Acute Respiratory and emerging Infection Consortium Clinical Characterization Protocol United Kingdom) study (ISARIC CCP-UK), is the largest of its kind and provides clear evidence that the continued use of NSAIDs in COVID-19 patients is safe.

“Evidence from community studies, administrative data, and small studies of hospitalized patients suggest NSAIDs are not associated with poorer COVID-19 outcomes,” the researchers explain. “We aimed to characterize the safety of NSAIDs and identify whether pre-existing NSAID use was associated with increased severity of COVID-19 disease.”

Included in the prospective, multicenter cohort study were 78,674 patients admitted to 255 healthcare facilities across England, Scotland, and Wales with a confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 between January 17 and August 10, 2020. Most, 56.2%, were men, and 5.8% of patients were recorded as taking systemic NSAIDs before admission.

After propensity-score matching, researchers created balanced groups of NSAID users and NSAID nonusers, with 4,205 patients in each group.

“At hospital admission, we observed no significant differences 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 (1.01, 0.87-1.17; P = .89), requirement for invasive ventilation (0.96, 0.80-1.17; P = .69), requirement for noninvasive ventilation (1.12, 0·96-1.32; P = .14), requirement for oxygen (1·00, 0·89-1.12; P = .97), or occurrence of acute kidney injury (1.08, 0.92-1.26; P = .33),” the authors concluded.

The study team further advised that policy makers consider reviewing advice around NSAID prescribing and COVID-19 severity.

Professor Ewen Harrison of the University of Edinburgh and lead author of the study, said, “NSAIDs are commonly used to treat people all over the world for a range of conditions, from minor aches and pains to chronic conditions such as arthritis and cardiovascular disease. Many people rely on them to be able to carry out their day-to-day activities. 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,” explained Dr. Harrison, MD, MBChB. “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.”

Limitations of the study include that it represented only 60% of hospitalized patients with SARS-C0V-2 infection in the UK over the study period and did not include patients with severe COVID-19 who were not hospitalized.

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