Patients prescribed NSAIDs for osteoarthritis are at no increased risk for COVID-19 incidence or mortality, a large new study shows, providing reassurance that the common drugs are safe during the pandemic.
Previously, concerns had been raised that NSAIDs might aggravate infection with the SARS-CoV-2 virus, and evidence from prior to the pandemic had suggested a potential link between NSAID use and prolonged or complicated respiratory infections.
In April of this year, the Commission on Human Medicines (CHM) issued guidance stating that there was insufficient evidence to link NSAID use and susceptibility to COVID-19 infection or mortality.
“Data on the effects of NSAIDs on susceptibility to SARS-CoV-2 remain sparse, especially in older cohorts,” wrote authors of the new study, led by Joht Singh Chandan, an academic clinical fellow at the Universities of Warwick and Birmingham.
The new study aimed to fill that gap by comparing more than 25,000 patients prescribed either NSAIDs or comparator drugs.
During the follow-up period, the incidence rate for suspected/confirmed COVID-19 was 15.4 per 1000 person-years in the NSAID group, and 19.9 per 1000 person-years in the comparator group.
This yielded adjusted hazard ratios both in an unmatched comparison and a propensity-matched analysis that were not significant. The same was true for mortality, with no difference between the two groups.
Importantly, there were also no risk differences seen when the results were stratified by age (under and over the age of 65 years). This was true for mortality risk as well.
“These findings are reassuring given the high prevalence of NSAID use in at-risk groups,” the authors wrote.
While other studies have not examined COVID-19 susceptibility, several have assessed whether NSAID use could make severe cases worse. For example, one study conducted in Denmark found no indication that this was the case.
Professor Anton Pottegård, a professor of pharmacoepidemiology at the University of Southern Denmark and the senior author on the Arthritis and Rheumatology study, emphasised that the initial safety concern was largely based on very loose anecdotal evidence and single case reports.
“Due to their cardiovascular and gastrointestinal safety profile, NSAIDs should always be used in the lowest dose and the shortest possible period of time,” he told the limbic.
“However, for patients with well-indicated NSAID use, there seems to be little reason to discontinue that treatment over fear of COVID-19 complications.”