TY - JOUR
AU - Drake, Thomas M.
PY - 2021
DA - May
TI - Non-steroidal anti-inflammatory drugs (NSAIDs) use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort
JO - The Lancet Rheumatology. 
DO - https://doi.org/10.1016/S2665-9913(21)00104-1
AB - Background: Reports suggested that existing use of non-steroidal anti-inflammatory drugs (NSAIDs) may lead to increased severity in patients with COVID-19. NSAIDs are an important analgesic, particularly in those with rheumatologic disease, and are widely available to the public without prescription. Evidence from community studies, administrative data and in small studies of hospitalised patients suggest NSAIDs are not associated with worse outcomes. Methods: Prospective, multicentre cohort study of patients hospitalised with COVID-19 in the UK between 17th January and 17th August 2020. The primary outcome was in-hospital mortality and secondary outcomes included disease severity at presentation, admission to critical care, receipt of invasive mechanical ventilation (IMV), receipt of noninvasive ventilation, use of supplementary oxygen and acute kidney injury. NSAID use was required to be within the 2 weeks prior to hospital admission. Logistic regression was used to estimate the effects of NSAIDs and adjust for confounding variables. Propensity score matching was used to further estimate effects of NSAIDS while accounting for covariate differences in populations. Effect estimates are presented as odds ratios (OR) with corresponding 95% confidence intervals. Results: 72,179 patients were included in the clinical characterisation protocol study across 255 healthcare facilities. Of these, 4211 (5.8%) used NSAIDs prior to hospital admission. Following propensity score matching, balanced groups of NSAIDs and non-NSAIDs users were obtained (n = 4205 each). On admission, there were no significant differences in severity between exposure groups. After adjusting for explanatory variables, NSAID use was not associated with worse overall survival (matched OR 0·95, 95% CI 0·84 to 1·07, p = 0·352), critical care admission (matched OR 1·01, 95% CI 0·87 to 1·17, p = 0·890), requirement for invasive ventilation (matched OR 0·96, 95% CI 0·80 to 1·17, p = 0·694), requirement for noninvasive ventilation (matched OR 1·12, 95% CI 0·96 to 1·32, p = 0·143), requirement for oxygen (matched OR 1·00, 95% CI 0·89 to 1·12, p = 0·968) or occurrence of acute kidney injury (matched OR 1 ·08, 95% CI 0·92 to 1·26, p = 0·330). Conclusions and Relevance: NSAID use is not associated with higher mortality or increased severity of COVID-19.
PB - Elsevier
UR - https://www.research.ed.ac.uk/portal/en/publications/nonsteroidal-antiinflammatory-drugs-nsaids-use-and-outcomes-of-covid19-in-the-isaric-clinical-characterisation-protocol-uk-cohort(8a59fb2f-7182-4d96-ae00-0b30d99f50c3).html
KW - Coronavirus (COVID-19)
ER