Prior Routine Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Important Outcomes in Hospitalised Patients with COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) infection causes acute lung injury, resulting from aggressive inflammation initiated by viral replication. There has been much speculation about the potential role of non-steroidal inflammatory drugs (NSAIDs), which increase the expression of angiotensin-converting enzyme 2 (ACE2), a binding target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to enter the host cell, which could lead to poorer outcomes in COVID-19 disease. The aim of this study was to examine the association between routine use of NSAIDs and outcomes in hospitalised patients with COVID-19. This was a multicentre, observational study, with data collected from adult patients with COVID-19 admitted to eight UK hospitals. Of 1222 patients eligible to be included, 54 (4.4%) were routinely prescribed NSAIDs prior to admission. Univariate results suggested a modest protective effect from the use of NSAIDs, but in the multivariable analysis, there was no association between prior NSAID use and time to mortality (adjusted HR (aHR) = 0.89, 95% CI 0.52-1.53, p = 0.67) or length of stay (aHR 0.89, 95% CI 0.59-1.35, p = 0.58). This study found no evidence that routine NSAID use was associated with higher COVID-19 mortality in hospitalised patients; therefore, patients should be advised to continue taking these medications until further evidence emerges. Our findings suggest that NSAID use might confer a modest benefit with regard to survival. However, as this finding was underpowered, further research is required.

Keywords: NSAIDs; SARS-CoV-2; covid-19; non-steroidal anti-inflammatory drugs.

Figure A1

Subgroups: time to mortality, adjusted hazard ratio are presented from the multivariable Cox PH model. Note: multivariable analyses adjusted for age group, sex, smoking status, hypertension, diabetes, CAD, kidney function and elevated CRP level.

Figure A2

Subgroup analysis, day-7 mortality. Mixed effects logistic regression, presenting the adjusted odds ratio from the logistic regression models. Note: multivariable analyses adjusted for age group, sex, smoking status, hypertension, diabetes, CAD, kidney function and elevated CRP level.

Figure A3

Subgroups: time to discharge, adjusted hazard ratio are presented from the multivariable Cox PH model. Note: multivariable analyses adjusted for age group, sex, smoking status, hypertension, diabetes, CAD, kidney function, and elevated CRP level.

Figure 1

NSAID use and mortality (shaded areas indicate 95% confidence intervals).