Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts

Abstract

ObjectivesTo assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform.MethodsWe conducted two cohort studies from 1 March to 14 June 2020. Working on behalf of National Health Service England, we used routine clinical data in England linked to death data. In study 1, we identified people with an NSAID prescription in the last 3 years from the general population. In study 2, we identified people with rheumatoid arthritis/osteoarthritis. We defined exposure as current NSAID prescription within the 4 months before 1 March 2020. We used Cox regression to estimate HRs for COVID-19 related death in people currently prescribed NSAIDs, compared with those not currently prescribed NSAIDs, accounting for age, sex, comorbidities, other medications and geographical region.ResultsIn study 1, we included 536 423 current NSAID users and 1 927 284 non-users in the general population. We observed no evidence of difference in risk of COVID-19 related death associated with current use (HR 0.96, 95% CI 0.80 to 1.14) in the multivariable-adjusted model. In study 2, we included 1 708 781 people with rheumatoid arthritis/osteoarthritis, of whom 175 495 (10%) were current NSAID users. In the multivariable-adjusted model, we observed a lower risk of COVID-19 related death (HR 0.78, 95% CI 0.64 to 0.94) associated with current use of NSAID versus non-use.ConclusionsWe found no evidence of a harmful effect of routinely prescribed NSAIDs on COVID-19 related deaths. Risks of COVID-19 do not need to influence decisions about the routine therapeutic use of NSAIDs.

NSAIDs and COVID-19: A Systematic Review and Meta-analysis

“…Ten papers described death in NSAID users [ 12 , 14 , 17 – 24 ], with various exposure periods, including current or acute exposure [ 12 , 14 , 25 ], or within 30 days [ 17 ] or 4 months [ 23 ].…”

“…Studies that provided different populations, such as OpenSAFELY, were treated as separate studies for each population. There were no duplicate patients (Wong et al [ 23 ]).…”

“…Four papers studied death in ibuprofen users, for current exposures [ 14 , 24 ], exposures of < 7 days [ 26 ] or exposures of < 4 months, in rheumatoid arthritis, or in the general population [ 23 ] (Table 2 d). The paper by Wong et al, in either the general population or the rheumatoid arthritis population, was considered as two different studies [ 23 ].…”

“…Removing the largest study (Wong et al [ 23 ]) did not significantly change the outcome (OR 0.89, 95% CI 0.77–1.02; I 2 = 23%) [not shown].…”

“Post-COVID syndrome”: The focus is on musculoskeletal pain

“…оценили частоту летальных исходов, связанных с COVID-19, у 536423 больных, получавших НПВП, и 1927284 лиц, не принимавших эти препараты, а также у 708781 больного РА и остеоартритом, 175495 из которых регулярно принимали НПВП. Было показано, что риск неблагоприятного исхода COVID-19 практически не различался у лиц, принимавших и не принимавших НПВП (отношение рисков (ОР) -0,98 (95% ДИ: 0,8-1,14)), и оказался даже ниже у пациентов с ревматическими заболеваниями, использовавшими эти препараты (ОР -0,78 (95% ДИ: 0,64-0,94) [50].…”