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The COVID-19 ibuprofen controversy: A systematic review of NSAIDs in adult acute lower respiratory tract infections.
Vaja, Ricky; Chan, Jeffrey Shi Kai; Ferreira, Plinio; Harky, Amer; Rogers, Luke J; Gashaw, Hime H; Kirkby, Nicholas S; Mitchell, Jane A.
  • Vaja R; Imperial College London, National Heart & Lung Institute, London, UK.
  • Chan JSK; Royal Brompton Hospital, London, UK.
  • Ferreira P; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
  • Harky A; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
  • Rogers LJ; Imperial College London, National Heart & Lung Institute, London, UK.
  • Gashaw HH; Liverpool Heart and Chest Hospital, Liverpool, UK.
  • Kirkby NS; University Hospitals Plymouth NHS Trust, Plymouth, UK.
  • Mitchell JA; Imperial College London, National Heart & Lung Institute, London, UK.
Br J Clin Pharmacol ; 87(3): 776-784, 2021 03.
Article in English | MEDLINE | ID: covidwho-717284
ABSTRACT

AIMS:

In light of the recent safety concerns relating to NSAID use in COVID-19, we sought to evaluate cardiovascular and respiratory complications in patients taking NSAIDs during acute lower respiratory tract infections.

METHODS:

We carried out a systematic review of randomised controlled trials and observational studies. Studies of adult patients with short-term NSAID use during acute lower respiratory tract infections, including bacterial and viral infections, were included. Primary outcome was all-cause mortality. Secondary outcomes were cardiovascular, renal and respiratory complications.

RESULTS:

In total, eight studies including two randomised controlled trials, three retrospective and three prospective observational studies enrolling 44 140 patients were included. Five of the studies were in patients with pneumonia, two in patients with influenza, and one in a patient with acute bronchitis. Meta-analysis was not possible due to significant heterogeneity. There was a trend towards a reduction in mortality and an increase in pleuro-pulmonary complications. However, all studies exhibited high risks of bias, primarily due to lack of adjustment for confounding variables. Cardiovascular outcomes were not reported by any of the included studies.

CONCLUSION:

In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution. Mechanistic and clinical studies addressing the captioned subject are urgently needed, especially in relation to COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Anti-Inflammatory Agents, Non-Steroidal / Ibuprofen / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Humans Language: English Journal: Br J Clin Pharmacol Year: 2021 Document Type: Article Affiliation country: Bcp.14514

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Anti-Inflammatory Agents, Non-Steroidal / Ibuprofen / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Humans Language: English Journal: Br J Clin Pharmacol Year: 2021 Document Type: Article Affiliation country: Bcp.14514