The answer, after a series of cautions and reversals, is that, as of March 18, the World Health Organization says it is aware of the concerns on the use of ibuprofen for the treatment of fever with COVID19 but does not recommend against its use. The organization adds in a Twitter response, “We are consulting with physicians treating the patients and are not aware of reports of any negative effects beyond the usual ones that limit its use in certain populations.”
The controversy started with online publication of a study in The Lancet Respiratory Medicine that addressed whether patients with hypertension and diabetes are at increased risk of developing the novel coronavirus infection.
In an effort to evaluate the question, University of Basel–led researchers cited three Chinese observational studies that had analyzed patient data from China and suggested that hypertension, diabetes, and cardiovascular diseases are more common in patients with severe or fatal cases of COVID-19 than in those with mild cases. The theory has since been supported by further studies from China and Italy.
The Basel researchers questioned whether drugs used to treat hypertension, diabetes, and cardiovascular diseases could play a part, pinpointing ACE inhibitors, which target the angiotensin-converting enzyme 2 (ACE2). ACE2 can also be increased by thiazolidinediones and ibuprofen, the study notes.
The authors emphasize that their discussion was meant for researchers, not patients, explaining, “This suspicion, which was expressly formulated as a hypothesis, is aimed at scientists with a view to further investigation based on additional patient data.”
“It does not constitute a recommendation to use certain drugs or not. Patients should always follow the instructions given by their physicians,” added coauthor Michael Roth, PhD, who leads a research group at the Department of Biomedicine of the University of Basel and University Hospital Basel.
A university press release notes, “In itself, the enzyme ACE2 is a very valuable protein that promotes tissue regeneration. Previous studies have shown that ACE inhibitors and angiotensin receptor blockers lead to increased formation of ACE2. Unfortunately, the coronavirus SARS-CoV-2 binds to this protein and uses it to enter cells, where it multiplies.”
Dr. Roth points out that similar relationships were described following the SARS pandemic of 2002-2003 and recommends “further research into the use of these drugs in COVID-19 patients.”
In a position statement, the International Pharmaceutical Federation [IPF] adds, that “in overall clinical practice, ibuprofen has a long- and well-established effectiveness in controlling the symptoms it is indicated for, both in mild and severe infectious disease. There is currently no conclusive evidence to establish a direct association between the use of non-steroidal anti-inflammatory medicines (including ibuprofen) and increased risk of infection with coronavirus/COVID-19 or severity of disease. Notwithstanding, other medicines such as paracetamol (acetaminophen) may be considered for the management of fever and mild pain in COVID19 patients if appropriate.”
The IPF also said that patients should continue their treatment with ACE inhibitors or ARBs unless specifically advised to stop by their medical team.
For a brief period of time, WHO advised that COVID-19 patients avoid taking ibuprofen, after French officials warned that anti-inflammatory drugs could worsen effects of the virus. That warning by French Minister Olivier Veran came after The Lancet study but before the authors’ explanation.
