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Open AccessArticle

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

1
Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland, UK
2
Institute of Applied Health Science, University of Aberdeen, Aberdeen AB25 2ZN, Scotland, UK
3
Royal Alexandra Hospital, Paisley PA2 9PJ, Scotland, UK
4
Department of Biostatistics & Health Informatics, King’s College London, London WC2R 2LS, UK
5
Salford Royal NHS Trust, Salford M6 8HD, UK
6
Glasgow Royal Infirmary, Glasgow G4 0SF, Scotland, UK
7
North Bristol NHS Trust, Bristol BS10 5NB, UK
8
School of Medicine, Cardiff University, Cardiff CF10 3AT, Wales, UK
*
Author to whom correspondence should be addressed.
These authors contributed equally.
These authors joint first authors.
§
These authors joint last authors.
J. Clin. Med. 2020, 9(8), 2586; https://doi.org/10.3390/jcm9082586
Received: 12 June 2020 / Revised: 14 July 2020 / Accepted: 4 August 2020 / Published: 10 August 2020
(This article belongs to the Special Issue COVID-19: From Pathophysiology to Clinical Practice)
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. View Full-Text
Keywords: covid-19; SARS-CoV-2; non-steroidal anti-inflammatory drugs; NSAIDs covid-19; SARS-CoV-2; non-steroidal anti-inflammatory drugs; NSAIDs
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Bruce, E.; Barlow-Pay, F.; Short, R.; Vilches-Moraga, A.; Price, A.; McGovern, A.; Braude, P.; Stechman, M.J.; Moug, S.; McCarthy, K.; Hewitt, J.; Carter, B.; Myint, P.K. Prior Routine Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Important Outcomes in Hospitalised Patients with COVID-19. J. Clin. Med. 2020, 9, 2586.

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