Ever since the French Minister of Health tweeted back in March 2020 that nonsteroidal anti-inflammatory drugs (NSAIDs) might increase the risk of COVID-19 infection, questions have lingered about the safety of these medications during the pandemic.
But new research published in the journal Arthritis & Rheumatology found no relationship between NSAID use and either susceptibility to COVID-19 infection or death among a large group of osteoarthritis patients. People with osteoarthritis frequently use nonsteroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin IB) and naproxen (Aleve) — to reduce pain and inflammation from the condition.
It all started when a brief report published in the Lancet on March 11 pointed out that NSAIDs can raise levels of the ACE2 enzyme. Because SARS-CoV-2, the virus that causes COVID-19, enters human cells through the ACE2 receptor, the authors expressed concern that taking NSAIDs may make it easier for the coronavirus to infect cells. That report presumably triggered the French tweet.
The authors of the more recent study accessed a large U.K. dataset of adult osteoarthritis patients in primary care settings, then compared 13,202 individuals who had been prescribed NSAIDs to 12,457 who were prescribed acetaminophen (Tylenol) plus codeine or acetaminophen plus dihydrocodeine. Codeine and dihydrocodeine are both opiates. Acetaminophen is a pain reliever but not an NSAID. The researchers followed the patients over the course of a few months (from January through July 2020) to track how many people in each group had a confirmed case of COVID-19 or died from any cause.
In the final analysis, the researchers found no meaningful difference between the groups when it came to susceptibility to COVID-19 or mortality. The authors noted that this is important given that many people with osteoarthritis who take NSAIDS may be considered at higher risk for coronavirus complications because of their age or other underlying health issues.
A perspective article in Healio Rheumatology notes that the study doesn’t give any insight into the risk of COVID-19 and COVID-19 mortality in patients with rheumatic diseases other than osteoarthritis, such as rheumatoid arthritis. It also didn’t look at dosages or different types of NSAIDs.
Still, the findings are “reassuring,” writes nurse practitioner Nicholas Manwaring, MSN, APRN, FNP-C, in the Healio perspective. “At least up to this point — the research supports the notion that NSAID use does not contribute to the COVID-19 related risks that have previously been well established,” he wrote.
The study authors noted that more research is needed to “investigate whether the use of NSAIDs is associated with adverse outcomes from COVID-19 in those with confirmed SARS-CoV-2 infection and whether risks differ by type and dose of NSAID.”
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Chandan JS, et al.Nonsteroidal anti‐inflammatory drugs and susceptibility to COVID‐19. Arthritis & Rheumatology. November 13, 2020. doi: https://doi.org/10.1002/art.41593.
Fang L., et al. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet. March 11, 2020. doi: https://doi.org/10.1016/ S2213-2600(20)30116-8.
Laday, J. NSAIDs not linked to increased COVID-19, mortality risk in OA. Healio Rheumatology. December 1, 2020. https://www.healio.com/news/rheumatology/20201201/nsaids-not-linked-to-increased-covid19-mortality-risk-in-oa.