US Pharm. 2020;45(4):2.

A recent study has found that there is no evidence for or against the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for patients with COVID-19. The study, led by researchers at King’s College London, also found other types of drugs, such as tumor necrosis factor (TNF) blockers and Janus kinase (JAK) inhibitors, safe to use.

Eighty-nine existing studies on other coronavirus strains such as Middle East respiratory syndrome and severe acute respiratory syndrome, as well as the limited literature on COVID-19, were analyzed to find out if certain pain medications, steroids, and other drugs used in people already suffering from these diseases should be avoided if they acquire COVID-19.

Some patients, for example those with cancer, are already given immunosuppressive drugs, therapies that can lower the body’s immune system, or immunostimulant drugs, therapies that boost it. If these patients acquire COVID-19, doctors need to know which medication to stop.

Dr. Mieke Van Hemelrijck, a cancer epidemiologist and an author on the study paper, said “This pandemic has led to challenging decision-making about the treatment of COVID-19 patients who were already critically unwell. In parallel, doctors across multiple specialties are making clinical decisions about the appropriate continuation of treatments for patients with chronic illnesses requiring immune suppressive medication.”

The article in ecancermedicalscience, an open-access oncology journal, is authored by researchers from Guy’s and St. Thomas NHS Foundation Trust, London, as well as those from King’s College London.

There had been some speculation that NSAIDs such as ibuprofen might make things worse for some COVID-19 patients, but the researchers did not find evidence to support this statement. Other types of drugs such as TNF blockers and JAK inhibitors, used to treat arthritis or other forms of inflammation, were also found to be safe to use. Another class of drug known as anti-interleukin-6 agents is being investigated for helping to fight COVID-19, although there is no conclusive proof yet.

The researchers found that low amounts of prednisolone or tacrolimus therapy may be helpful in treating COVID-19. Coauthor Dr. Sophie Papa, a medical oncologist and immunologist, said, “Current evidence suggests that low-dose prednisolone (a steroid used to treat allergies) and tacrolimus therapy (an immunosuppressive drug given to patients who have had an organ transplant) may have beneficial impact on the course of coronavirus infections. However, further investigation is needed.”

As COVID-19 infects more people, the researchers will continue to investigate how it interacts with commonly used medications and make further guidance recommendations.

For other late-breaking clinical news surrounding the COVID-19 pandemic, see page 28. In addition, the Patient Teaching Aid, page 13, guides pharmacists in counseling patients about COVID-19.

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