OpenSAFELY: Do adults prescribed Non-steroidal anti-inflammatory drugs have an increased risk of death from COVID-19?

ABSTRACT

ImportanceThere has been speculation that non-steroidal anti-inflammatory drugs (NSAIDs) may negatively affect coronavirus disease 2019 (COVID-19) outcomes, yet clinical evidence is limited. ObjectiveTo assess the association between NSAID use and deaths from COVID-19 using OpenSAFELY, a secure analytical platform. DesignTwo cohort studies (1st March-14th June 2020). SettingWorking on behalf of NHS England, we used routine clinical data from >17 million patients in England linked to death data from the Office for National Statistics. ParticipantsStudy 1 General population (people with an NSAID prescription in the last three years). Study 2 people with rheumatoid arthritis/osteoarthritis. ExposuresCurrent NSAID prescription within the 4 months before 1st March 2020. Main Outcome and MeasureWe used Cox regression to estimate hazard ratios (HRs) for COVID-19 related death in people currently prescribed NSAIDs, compared with those not currently prescribed NSAIDs, adjusting for age, sex, comorbidities and other medications. ResultsIn Study 1, we included 535,519 current NSAID users and 1,924,095 non-users in the general population. The crude HR for current use was 1.25 (95% CI, 1.07-1.46), versus non-use. We observed no evidence of difference in risk of COVID-19 related death associated with current use (HR, 0.95, 95% CI, 0.80-1.13) in the fully adjusted model. In Study 2, we included 1,711,052 people with rheumatoid arthritis/osteoarthritis, of whom 175,631 (10%) were current NSAID users. The crude HR for current use was 0.43 (95% CI, 0.36-0.52), versus non-use. In the fully adjusted model, we observed a lower risk of COVID-19 related death (HR, 0.78, 95% CI, 0.65-0.94) associated with current use of NSAID versus non-use. Conclusion and RelevanceWe found no evidence of a harmful effect of NSAIDs on COVID-19 related deaths. Risks of COVID-19 do not need to influence decisions about therapeutic use of NSAIDs.