J Clin Pharmacol . The Risk of SARS-COV-2 Infection and Covid-19 Severity Associated with The Exposure to Non-Steroidal Anti-Inflammatory Drugs: Systematic Review and Meta-Analysis

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J Clin Pharmacol


. 2021 Aug 5.
doi: 10.1002/jcph.1949. Online ahead of print.
The Risk of SARS-COV-2 Infection and Covid-19 Severity Associated with The Exposure to Non-Steroidal Anti-Inflammatory Drugs: Systematic Review and Meta-Analysis


Luísa Prada ¹ , Catarina D Santos ¹ , Rita A Baião ¹ , João Costa ^{1 2} , Joaquim J Ferreira ^{1 2 3} , Daniel Caldeira ^{1 2 4 5}



Affiliations

• PMID: 34352112
• DOI: 10.1002/jcph.1949

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) were thought to increase the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus entrance into cells. Hence, it was suggested in the media that NSAIDs could lead to a higher risk of infection and/or disease severity. To determine the existence or absence of this association, we aimed to systematically evaluate the risk of SARS-CoV-2 infection and mortality and the risk of severe coronavirus disease 2019 (COVID-19) associated with previous exposure to NSAIDs. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were searched in February 2021 for controlled studies. The results were calculated through random-effect meta-analyses and reported in terms of odds ratio (OR) with 95% confidence intervals (CI). Heterogeneity was assessed with I² test. Eleven studies were included, comprising a total of 683 715 patients. NSAID exposure did not increase the risk of having a positive test for SARS-CoV-2 infection (OR 0.97, 95% CI 0.85-1.11, I² = 24%, five studies). The exposure to NSAIDs did not increase the risk of severe/critical COVID-19 disease (OR 0.92, 95% CI 0.80-1.05, I² = 0%, 5 studies) nor all-cause mortality among patients with COVID-19 (OR 0.86, 95% CI 0.75-0.99, I² = 14%, four studies). Our data did not suggest that exposure to NSAIDs increases the risk of having SARS-CoV-2 infection or increases the severity of COVID-19 disease. Also, the fragility of the studies included precludes definite conclusions and highlights the need for further robust data. Systematic review registration number: CRD42020216806 This article is protected by copyright. All rights reserved.

Keywords: ACE-2; COVID-19; NSAIDs; SARS-CoV-2; non-steroid anti-inflammatory drugs.