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No Evidence That NSAIDS, Other Drugs Are Unsafe for Coronavirus Patients

One of the struggles in treating novel coronavirus, especially in an older high-risk population with multiple co-morbidities, is determining how current medications affect recovery. A new study analyzed nearly 90 clinical studies on the topic and found, among other things, no evidence demonstrating that non-steroidal anti-inflammatory drugs are dangerous for patients with COVID-19 infection. Here is more information.

LONDON – Despite mounting concerns about using non-steroidal anti-inflammatory drugs such as ibuprofen for patients with COVID-19, a recent study found little evidence for or against.

The article published in ecancermedicalscience, an open access journal also found evidence that TNF blockers and JAK inhibitors are safe to use.

Kings College London-led researchers analyzed 89 existing studies on other coronavirus strains such as MERS and SARS, as well as the limited literature on COVID-19, to tease out if certain pain medications, steroids, and other medications should be avoided in case of COVID-19 infection.

"This pandemic has led to challenging decision-making about the treatment of COVID-19 patients who were already critically unwell. In parallel, doctors across multiple specialties are making clinical decisions about the appropriate continuation of treatments for patients with chronic illnesses requiring immune suppressive medication,” notes co-author Mieke Van Hemelrijck, PhD.

Background information in the study discusses how cancer and transplant patients with COVID-19 have a higher risk of developing severe and even fatal respiratory diseases, especially if they are treated with immune-suppressive or immune-stimulating drugs.

To determine more about that,the authors used Ovid MEDLINE to review current evidence for immune-suppressing or -stimulating drugs: cytotoxic chemotherapy, low-dose steroids, tumor necrosis factorα (TNFα) blockers, interlukin-6 (IL-6) blockade, Janus kinase (JAK) inhibitors, IL-1 blockade, mycophenolate, tacrolimus, anti-CD20 and CTLA4-Ig.

The UK study team reached the following conclusions:

• Cytotoxic chemotherapy has been shown to be a specific inhibitor for severe acute respiratory syndrome coronavirus in in vitrostudies, but no specific studies exist as of yet for COVID-19.
• No conclusive evidence for or against the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of COVID-19 patients is available, nor is there evidence indicating that TNFα blockade is harmful to patients in the context of COVID-19.
• COVID-19 has been observed to induce a pro-inflammatory cytokine generation and secretion of cytokines, such as IL-6, but there is no evidence of the beneficial impact of IL-6 inhibitors on the modulation of COVID-19.
• Although there are potential targets in the JAK-STAT pathway that can be manipulated in treatment for coronaviruses and it is evident that IL-1 is elevated in patients with a coronavirus, there is currently no evidence for a role of these drugs in treatment of COVID-19.

“The COVID-19 pandemic has led to challenging decision-making about treatment of critically unwell patients,” the authors explain. “Low-dose prednisolone and tacrolimus may have beneficial impacts on COVID-19. The mycophenolate mofetil picture is less clear, with conflicting data from pre-clinical studies. There is no definitive evidence that specific cytotoxic drugs, low-dose methotrexate for auto-immune disease, NSAIDs, JAK kinase inhibitors or anti-TNFα agents are contraindicated. There is clear evidence that IL-6 peak levels are associated with severity of pulmonary complications.”

Despite some speculation – and widespread social media discussion -- that NSAIDS such as ibuprofen might worsen the conditions of COVID-19 patients, researchers said they did not find evidence to support that.