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

Eilidh Bruce; Fenella Barlow-Pay; Roxanna Short; Arturo Vilches-Moraga; Angeline Price; Aine McGovern; Philip Braude; Michael J. Stechman; Susan Moug; Kathryn McCarthy; Jonathan Hewitt; Ben Carter; Phyo Kyaw Myint

doi:10.3390/jcm9082586

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

Eilidh Bruce, Fenella Barlow-Pay, Roxanna Short, Arturo Vilches-Moraga, Angeline Price, Aine McGovern, Philip Braude, Michael J. Stechman, Susan Moug, Kathryn McCarthy, Jonathan Hewitt, Ben Carter, Phyo Kyaw Myint^* (Corresponding Author)

^*Corresponding author for this work

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Abstract

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

Original language	English
Article number	2586
Number of pages	13
Journal	Journal of Clinical Medicine
Volume	9
Issue number	8
DOIs	https://doi.org/10.3390/jcm9082586
Publication status	Published - 10 Aug 2020

Keywords

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. (2020). Prior Routine use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Important Outcomes in Hospitalised Patients with COVID-19. Journal of Clinical Medicine, 9(8), [ 2586]. https://doi.org/10.3390/jcm9082586

Prior Routine use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Important Outcomes in Hospitalised Patients with COVID-19. / Bruce, Eilidh; Barlow-Pay, Fenella; Short, Roxanna; Vilches-Moraga, Arturo; Price, Angeline; McGovern, Aine; Braude, Philip; Stechman, Michael J.; Moug, Susan; McCarthy, Kathryn; Hewitt, Jonathan; Carter, Ben; Myint, Phyo Kyaw (Corresponding Author).

In: Journal of Clinical Medicine, Vol. 9, No. 8, 2586, 10.08.2020.

Research output: Contribution to journal › Article › peer-review

Bruce, E, Barlow-Pay, F, Short, R, Vilches-Moraga, A, Price, A, McGovern, A, Braude, P, Stechman, MJ, Moug, S, McCarthy, K, Hewitt, J, Carter, B & Myint, PK 2020, 'Prior Routine use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Important Outcomes in Hospitalised Patients with COVID-19', Journal of Clinical Medicine, vol. 9, no. 8, 2586. https://doi.org/10.3390/jcm9082586

Bruce, Eilidh ; Barlow-Pay, Fenella ; Short, Roxanna ; Vilches-Moraga, Arturo ; Price, Angeline ; McGovern, Aine ; Braude, Philip ; Stechman, Michael J. ; Moug, Susan ; McCarthy, Kathryn ; Hewitt, Jonathan ; Carter, Ben ; Myint, Phyo Kyaw. / Prior Routine use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Important Outcomes in Hospitalised Patients with COVID-19. In: Journal of Clinical Medicine. 2020 ; Vol. 9, No. 8.

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abstract = "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",

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author = "Eilidh Bruce and Fenella Barlow-Pay and Roxanna Short and Arturo Vilches-Moraga and Angeline Price and Aine McGovern and Philip Braude and Stechman, {Michael J.} and Susan Moug and Kathryn McCarthy and Jonathan Hewitt and Ben Carter and Myint, {Phyo Kyaw}",

note = "Acknowledgments: We gratefully acknowledge the collaborators of the study listed below: Ross Alexander, Emma Bhatti, Carly Bisset, Alice Cavenagh, Jemima Collins, Charlotte Davey, Siobhan Duffy, Jenny Edwards, Alice G Einarsson, Norman Galbraith, Madeline Garcia, James Hesford, Mark Holloway, Tarik Jichi, Joanna Kelly, Sheila Jones, Thomas Kneen, Thomas Lee, Kiah Lunstone, Emma Mitchell, Dolcie Paxton, Lyndsay Pearce, Terence J Quinn, Frances Rickard, Shefali Sangani, Rebecca Simmons, Sandeep Singh, Charlotte Silver, Thomas Telford, Alessia Verduri.",

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AU - Short, Roxanna

AU - Vilches-Moraga, Arturo

AU - Price, Angeline

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N2 - 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

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