Br J Clin Pharmacol . Prevalence of NSAID use among people with COVID-19 and the association with COVID-19 related outcomes: systematic review and meta-analysis

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Br J Clin Pharmacol


. 2022 Aug 27.
doi: 10.1111/bcp.15512. Online ahead of print.
Prevalence of NSAID use among people with COVID-19 and the association with COVID-19 related outcomes: systematic review and meta-analysis


M D Huilei Zhao ¹ , M D Shanshan Huang ² , M D Shan Huang ³ , M D Fuwei Liu ⁴ , B D Wen Shao ² , M D Kaibo Mei ⁵ , M D Jianyong Ma ⁶ , Yuan Jiang ⁷ , M D Jingfeng Wan ⁸ , M D Wengen Zhu ⁹ , M D Peng Yu ² , M D Xiao Liu ⁸



Affiliations

• PMID: 36029185
• DOI: 10.1111/bcp.15512

Abstract

Aim: Recent reports of potential harmful effects of nonsteroidal anti-inflammatory drugs (NSAIDs) in treating patients with Coronavirus Disease 2019 (COVID-19) have raised great concern.
Methods: We searched the PubMed, EMBASE, Cochrane Library and MedRxiv databases to examine the prevalence of NSAID use and associated COVID-19 risk, outcomes, and safety.
Results: Twenty-five studies with a total of 101,215 COVID-19 patients were included. Prevalence of NSAID use amongCOVID-19 patients was 18% [No. of studies(n)=22] and NSAIDs use prior to admission or diagnosis of COVID-19 was not associated with an increased risk of COVID-19 (adjusted odds ratio [aOR]=0.98, 95% confidence interval [CI]: 0.78-1.24; I² =82%, n=3), hospitalization (aOR=1.06, 95%CI: 0.76-1.48; I² =81%, n=5), mechanical ventilation (aOR=0.71, 95%CI: 0.47-1.06; I² =38%, n=4), and length of hospital stay. Moreover, prior use of NSAIDs was associated with a decreased risk of severe COVID-19 (aOR=0.79, 95%CI: 0.71-0.89; I² =0%, n=7) and death (aOR: 0.72, 95%CI: 0.54-0.96; I2=86%, n=9). Prior NSAID administration might also be associated with an increased risk of stroke (aOR=2.32, 95%CI: 1.04-5.2; I² =0, n=2), but not myocardial infarction (aOR=1.49, 95%CI: 0.25-8.92; I² =0, n=2) and composite thrombotic events (aOR= OR=1.56, 95%CI: 0.66-3.69; I² =52%, n=2).
Conclusion: Based on current evidence, NSAID use prior to admission or diagnosis of COVID-19 was not linked with an increased odds or exacerbation of COVID-19. NSAIDs might provide a survival benefit, although they might potentially increase the risk of stroke. Controlled trials are still required to further assess the clinical benefit and safety (e.g., stroke and acute renal failure) of NSAIDs in treating patients with COVID-19.

Keywords: aspirin; corona Virus Disease 2019; ibuprofen; meta-analysis; naproxen; nonsteroidal anti-inflammatory drugs; systematic review.