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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
Semantic information from SemMedBD (by NLM)
1. Acute lower respiratory tract infection PROCESS_OF Adult
Subject
Acute lower respiratory tract infection
Predicate
PROCESS_OF
Object
Adult
2. Anti-Inflammatory Agent TREATS C0238990
Subject
Anti-Inflammatory Agent
Predicate
TREATS
Object
C0238990
3. Anti-Inflammatory Agent ADMINISTERED_TO C0030705
Subject
Anti-Inflammatory Agent
Predicate
ADMINISTERED_TO
Object
C0030705
4. Respiratory complication PROCESS_OF Patients
Subject
Respiratory complication
Predicate
PROCESS_OF
Object
Patients
5. Respiratory complication COEXISTS_WITH Acute lower respiratory tract infection
Subject
Respiratory complication
Predicate
COEXISTS_WITH
Object
Acute lower respiratory tract infection
6. Acute bronchitis PROCESS_OF Patients
Subject
Acute bronchitis
Predicate
PROCESS_OF
Object
Patients
7. Influenza PROCESS_OF Patients
Subject
Influenza
Predicate
PROCESS_OF
Object
Patients
8. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
Predicate
PROCESS_OF
Object
Patients
9. Acute lower respiratory tract infection PROCESS_OF Adult
Subject
Acute lower respiratory tract infection
Predicate
PROCESS_OF
Object
Adult
10. Anti-Inflammatory Agents, Non-Steroidal TREATS Acute lower respiratory tract infection
Subject
Anti-Inflammatory Agents, Non-Steroidal
Predicate
TREATS
Object
Acute lower respiratory tract infection
11. Anti-Inflammatory Agents, Non-Steroidal ADMINISTERED_TO Patients
Subject
Anti-Inflammatory Agents, Non-Steroidal
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ADMINISTERED_TO
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Patients
12. Respiratory complication PROCESS_OF Patients
Subject
Respiratory complication
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PROCESS_OF
Object
Patients
13. Respiratory complication COEXISTS_WITH Acute lower respiratory tract infection
Subject
Respiratory complication
Predicate
COEXISTS_WITH
Object
Acute lower respiratory tract infection
14. Acute bronchitis PROCESS_OF Patients
Subject
Acute bronchitis
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PROCESS_OF
Object
Patients
15. Influenza PROCESS_OF Patients
Subject
Influenza
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PROCESS_OF
Object
Patients
16. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
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PROCESS_OF
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Patients
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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Anti-Inflammatory Agents, Non-Steroidal / Ibuprofen / COVID-19 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 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