WHO has Published a Review of NSAIDs in Patients with CHOVID-19

22 April 2020

GMP News

At present there is no evidence of severe adverse events, acute health care utilization, long-term survival, or quality of life in patients with COVID-19, as a result of the use of NSAIDs.

A rapid systematic review was carried out on 20 March 2020 on NSAIDs and viral respiratory infections using MEDLINE, EMBASE, and WHO Global Database. The review aimed to assess the effects of prior and current use of NSAIDs in patients with acute viral respiratory infections on acute severe adverse events (including mortality, the acute respiratory distress syndrome (ARDS), acute organ failure, and opportunistic infections), on acute health care utilization (including hospitalization, intensive care unit (ICU) admission, supplemental oxygen therapy, and mechanical ventilation) as well as on quality of life and long-term survival.

A total of 73 studies were included (28 studies in adults, 46 studies in children, and one study in adults and children). All studies were concerned with acute viral respiratory infections or conditions commonly caused by respiratory viruses, but none specifically addressed COVID-19, SARS, or MERS. The review showed very low certainty evidence on mortality among adults and children. Effects of NSAIDs on the risk for ischemic and haemorrhagic stroke and myocardial infarction in adults with acute respiratory infections are unclear. Moderate to high certainty evidence showed little or no difference between ibuprofen and acetaminophen (paracetamol) among children with fever with regard to effects on death from all causes, hospitalization for any cause, acute renal failure, and acute gastrointestinal bleeding. Most studies report that no severe adverse events occurred, or that only mild or moderate adverse events were observed.

Therefore, all evidence included should be considered indirect evidence with respect to the use of NSAIDs prior to or during the management of COVID-19.

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs, and have a wide range of uses. NSAIDs include nonselective cyclooxygenase (COX) inhibitors (such as ibuprofen, aspirin (acetylsalicylate), diclofenac, and naproxen), as well as selective COX2 inhibitors (such as celecoxib, rofecoxib, etoricoxib, lumiracoxib, and valecoxib).

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