Non‐steroidal anti‐inflammatory drugs in management of COVID‐19; A systematic review on current evidence

Abstract

Background Since there is still no definitive conclusion regarding which non‐steroidal anti‐inflammatory drugs (NSAIDs) are most effective and safe in viral respiratory infections, we decided to evaluate the efficacy and safety of various NSAIDs in viral respiratory infections so that we can reach a conclusion on which NSAID is best choice for coronavirus disease 2019 (COVID‐19). Methods A search was performed in Medline (via PubMed), Embase and CENTRAL databases until 23 March 2020. Clinical trials on application of NSAIDs in viral respiratory infections were included. Results Six clinical trials were included. No clinical trial has been performed on COVID‐19, Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome infections. Studies show that ibuprofen and naproxen not only have positive effects in controlling cold symptoms, but also do not cause serious side effects in rhinovirus infections. In addition, it was found that clarithromycin, naproxen and oseltamivir combination leads to decrease in mortality rate and duration of hospitalisation in patients with pneumonia caused by influenza. Conclusion Although based on existing evidence, NSAIDs have been effective in treating respiratory infections caused by influenza and rhinovirus, since there is no clinical trial on COVID‐19 and case‐reports and clinical experiences are indicative of elongation of treatment duration and exacerbation of the clinical course of patients with COVID‐19, it is recommended to use substitutes such as acetaminophen for controlling fever and inflammation and be cautious about using NSAIDs in management of COVID‐19 patients until there are enough evidence. Naproxen may be a good choice for future clinical trials.

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

“…Whilst systematic reviews have concluded that there is insufficient evidence to determine the effect of NSAIDs in COVID-19 patients [16][17][18][19], advising against drastic changes to drug regimens, alternative literature recommends that NSAIDs should be avoided until evidence emerges [20]. Many of the studies referenced within literature reviews are in relation to respiratory viruses other than SARS-CoV-2.…”

“…Following recognition that the angiotensin-converting enzyme 2 receptor (ACE2) serves as a binding site for SARS CoV-2 to enter the host cell, a number of European authorities, including those in France and Belgium, issued federal reports suggesting that the use of non-steroidal inflammatory drugs (NSAIDs) in the presence of COVID-19 might adversely affect patients' clinical course and recovery [2]. There remains, however, a considerable uncertainty regarding the use of common NSAIDs and their effect on COVID- 19.…”

Detection of SARS-CoV-2 using five primer sets

“…Until today, no treatments have been found for treating SARS-CoV-2. However, several options including antiviral drugs such as Favipirarvir, Lopinavir, Ritonavir (3), anti-inflammatory agents such as Baricitinib, Ruxolitinib, Fedratinib (19) and other drugs such as chloroquine (18) have been used to improve clinical symptoms of the infection (30,31). Oropharyngeal and nasopharyngeal swabs samples of one hundred of consecutive patients (55% male; 45% female) with confirmed SARS-CoV-2 from June 1 to July 20, 2020, were used for all analysis in this study.…”

Favipiravir versus other antiviral or standard of care for COVID-19 treatment: A rapid systematic review and meta-analysis

“…The road to discover effective prophylaxis and treatment is still an ongoing process. Numerous trials of medications of different categories have been conducted but none have succeeded to show promising results for effective treatment [5,6]. Some of the repurposed drugs are being utilized along with supportive care for the management of COVID-19 in different clinical settings.…”