Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort: a matched, prospective cohort study.



Drake, Thomas M, Fairfield, Cameron J, Pius, Riinu, Knight, Stephen R, Norman, Lisa, Girvan, Michelle, Hardwick, Hayley E, Docherty, Annemarie B, Thwaites, Ryan S, Openshaw, Peter JM
et al (show 4 more authors) (2021) Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort: a matched, prospective cohort study. The Lancet. Rheumatology, 3 (7). e498 - e506.

WarningThere is a more recent version of this item available.
Access the full-text of this item by clicking on the Open Access link.
[img] Text
PIIS2665991321001041.pdf - Published version
Available under License : See the attached licence file.

Download (610kB)
[img] Text
PIIS2665991321001041.pdf - Published version
Available under License : See the attached licence file.

Download (610kB)
[img] Text
PIIS2665991321001041.pdf - Published version
Available under License : See the attached licence file.

Download (610kB)
[img] Text
PIIS2665991321001041.pdf - Published version
Available under License : See the attached licence file.

Download (610kB)
[img] Text
PIIS2665991321001041.pdf - Published version
Available under License : See the attached licence file.

Download (610kB)
[img] Text
PIIS2665991321001041.pdf - Published version
Available under License : See the attached licence file.

Download (610kB)
[img] Text
PIIS2665991321001041.pdf - Published version
Available under License : See the attached licence file.

Download (610kB)

Abstract

<h4>Background</h4>Early in the pandemic it was suggested that pre-existing use of non-steroidal anti-inflammatory drugs (NSAIDs) could lead to increased disease severity in patients with COVID-19. NSAIDs are an important analgesic, particularly in those with rheumatological disease, and are widely available to the general public without prescription. Evidence from community studies, administrative data, and small studies of hospitalised patients suggest NSAIDs are not associated with poorer COVID-19 outcomes. We aimed to characterise the safety of NSAIDs and identify whether pre-existing NSAID use was associated with increased severity of COVID-19 disease.<h4>Methods</h4>This prospective, multicentre cohort study included patients of any age admitted to hospital with a confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 between Jan 17 and Aug 10, 2020. The primary outcome was in-hospital mortality, and secondary outcomes were disease severity at presentation, admission to critical care, receipt of invasive ventilation, receipt of non-invasive ventilation, use of supplementary oxygen, and acute kidney injury. NSAID use was required to be within the 2 weeks before hospital admission. We used logistic regression to estimate the effects of NSAIDs and adjust for confounding variables. We used propensity score matching to further estimate effects of NSAIDS while accounting for covariate differences in populations.<h4>Results</h4>Between Jan 17 and Aug 10, 2020, we enrolled 78 674 patients across 255 health-care facilities in England, Scotland, and Wales. 72 179 patients had death outcomes available for matching; 40 406 (56·2%) of 71 915 were men, 31 509 (43·8%) were women. In this cohort, 4211 (5·8%) patients were recorded as taking systemic NSAIDs before admission to hospital. Following propensity score matching, balanced groups of NSAIDs users and NSAIDs non-users were obtained (4205 patients in each group). At hospital admission, we observed no significant differences in severity between exposure groups. After adjusting for explanatory variables, NSAID use was not associated with worse in-hospital mortality (matched OR 0·95, 95% CI 0·84-1·07; p=0·35), critical care admission (1·01, 0·87-1·17; p=0·89), requirement for invasive ventilation (0·96, 0·80-1·17; p=0·69), requirement for non-invasive ventilation (1·12, 0·96-1·32; p=0·14), requirement for oxygen (1·00, 0·89-1·12; p=0·97), or occurrence of acute kidney injury (1·08, 0·92-1·26; p=0·33).<h4>Interpretation</h4>NSAID use is not associated with higher mortality or increased severity of COVID-19. Policy makers should consider reviewing issued advice around NSAID prescribing and COVID-19 severity.<h4>Funding</h4>National Institute for Health Research and Medical Research Council.

Item Type: Article
Uncontrolled Keywords: ISARIC4C Investigators
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Clinical Directorate
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 18 Oct 2021 14:59
Last Modified: 18 Jan 2023 21:26
DOI: 10.1016/s2665-9913(21)00104-1
Open Access URL: https://doi.org/10.1016/S2665-9913(21)00104-1
URI: https://livrepository.liverpool.ac.uk/id/eprint/3140528

Available Versions of this Item