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Associations Between the Use of Non-Steroidal Anti-Inflammatory Drugs and Adverse Outcomes Among Patients with COVID-19: A Systematic Review and Meta-Analysis

47 Pages Posted: 12 Aug 2021

See all articles by Qi Zhou

Qi Zhou

Lanzhou University

Siya Zhao

Lanzhou University

Lidan Gan

Chongqing Medical University

Zhili Wang

Chongqing Medical University

Shuai Peng

Chongqing Medical University

Qinyuan Li

Chongqing Medical University

Hui Liu

Lanzhou University

Xiao Liu

Lanzhou University

Zijun Wang

Lanzhou University

Qianling Shi

Lanzhou University

Janne Estill

University of Geneva - Institute of Global Health

Zhengxiu Luo

Chongqing Medical University

Xiaohui Wang

Lanzhou University

En-Mei Liu

Chongqing Medical University - Department of Respiratory Medicine; Chongqing Medical University - National Clinical Research Center for Child Health and Disorders; Chongqing Key Laboratory of Pediatrics

Yaolong Chen

Lanzhou University - Evidence-Based Medicine Center; Lanzhou University - Lanzhou University Institute of Health Data Science; Lanzhou University - School of Public Health; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation; Lanzhou University - Lanzhou University GRADE Center

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Abstract

Background: There are concerns that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of adverse outcomes in COVID-19 patients. Therefore, this study aimed to synthesize the existing evidence on associations between the use of NSAIDs and adverse outcomes among patients with COVID-19.

Methods: Systematic search of WHO COVID-19 Database, Medline, The Cochrane Library, Web of Science, Embase, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Database for all articles published from January 1, 2020, to August 10, 2021, as well as a supplementary search of Google Scholar. We included comparative observational studies and randomized controlled trials that enrolled patients with COVID-19 who took NSAIDs before or after diagnosis of COVID-19. Data extraction and quality assessment of methodology of included studies were completed by two reviewers independently. We conducted a meta-anlysis on the main outcomes, as well as selected subgroup analyses stratified by the type of NSAID.

Fingings: Fifteen non-randomized studies evaluating 24700 adult COVID-19 patients were identified. The use of NSAIDs in patients with COVID-19, compared with no use of NSAIDs, was not significantly associated with an elevated mortality (odds ratio [OR]=0.94, 95% confidence interval [CI]: 0.87 to 1.02), or an increased probability of ICU admission (OR=1.35, 95% CI: 0.73 to 2.49), requiring mechanical ventilation (OR=1.23, 95% CI: 0.71 to 2.13), or administration of supplemental oxygen (OR=0.99, 95% CI: 0.91 to 1.08). The subgroup analyses revealed that the use of ibuprofen (OR=1.22, 95% CI: 0.32 to 4.60), etoricoxib (OR=0.36, 95% CI: 0.02 to 6.49) or celecoxib (zero deaths in both groups) were not associated with an increased risk of death in COVID-19 patients, compared with not using any NSAID.

Interpretation: Fever is one of the main clinical symptoms of COVID-19. According to our findings, NSAIDs such as ibuprofen can be used to treat fever in COVID-19 patients safely.

Funding: None to declare.

Declaration of Interest: None to declare.

Keywords: NSAIDs, COVID-19, Systematic review, Meta-analysis

Suggested Citation

Zhou, Qi and Zhao, Siya and Gan, Lidan and Wang, Zhili and Peng, Shuai and Li, Qinyuan and Liu, Hui and Liu, Xiao and Wang, Zijun and Shi, Qianling and Estill, Janne and Luo, Zhengxiu and Wang, Xiaohui and Liu, En-Mei and Chen, Yaolong, Associations Between the Use of Non-Steroidal Anti-Inflammatory Drugs and Adverse Outcomes Among Patients with COVID-19: A Systematic Review and Meta-Analysis. Available at SSRN: https://ssrn.com/abstract=3903939 or http://dx.doi.org/10.2139/ssrn.3903939

Qi Zhou

Lanzhou University ( email )

222 Tianshui South Road
Chengguan
Lanzhou, gansu 730000
China

Siya Zhao

Lanzhou University ( email )

222 Tianshui South Road
Chengguan
Lanzhou, gansu 730000
China

Lidan Gan

Chongqing Medical University ( email )

China

Zhili Wang

Chongqing Medical University ( email )

China

Shuai Peng

Chongqing Medical University ( email )

China

Qinyuan Li

Chongqing Medical University ( email )

China

Hui Liu

Lanzhou University

Xiao Liu

Lanzhou University

222 Tianshui South Road
Chengguan
Lanzhou, gansu 730000
China

Zijun Wang

Lanzhou University ( email )

222 Tianshui South Road
Chengguan
Lanzhou, gansu 730000
China

Qianling Shi

Lanzhou University ( email )

222 Tianshui South Road
Chengguan
Lanzhou, gansu 730000
China

Janne Estill

University of Geneva - Institute of Global Health ( email )

Geneva
Switzerland

Zhengxiu Luo

Chongqing Medical University ( email )

China

Xiaohui Wang

Lanzhou University

222 Tianshui South Road
Chengguan
Lanzhou, gansu 730000
China

En-Mei Liu

Chongqing Medical University - Department of Respiratory Medicine ( email )

Chongqing
China

Chongqing Medical University - National Clinical Research Center for Child Health and Disorders

Chongqing
China

Chongqing Key Laboratory of Pediatrics

Chongqing
China

Yaolong Chen (Contact Author)

Lanzhou University - Evidence-Based Medicine Center ( email )

No.199, Donggang West Road
Chengguan District
Lanzhou, 730000
China

Lanzhou University - Lanzhou University Institute of Health Data Science

Lanzhou
China

Lanzhou University - School of Public Health

China

WHO Collaborating Centre for Guideline Implementation and Knowledge Translation

Lanzhou
China

Lanzhou University - Lanzhou University GRADE Center

Lanzhou
China

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