Nonsteroidal anti-inflammatory drugs and ibuprofen for COVID-19: a systematic review

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Abstract

COVID-19 pandemic is currently the most pressing public health problem worldwide. Despite growing knowledge about the nature of SARS-CoV-2-assosiated severe acute respiratory syndrome, the treatment options are still poorly defined. The safety of nonsteroidal anti-inflammatory drugs (NSAIDs), in particular ibuprofen, has been questioned without any supporting evidence. This has contributed to a number of observational studies evaluating the effect of ibuprofen on COVID-19 disease outcomes. A search of publications was carried out and a systematic review of 9 studies was presented, pharmacodynamic effects of ibuprofen were considered in terms of the effect on angiotensin-converting enzyme 2 and cyclooxygenase. The studies data have shown no direct interaction between ibuprofen and SARS-CoV-2, no evidence that ibuprofen affects the up-regulation of angiotensin-converting enzyme 2 as a COVID-19 receptor in human studies. Observational studies have not found evidence that ibuprofen, when used chronically before COVID-19 or when acutely used to relieve symptoms of COVID-19, contributes to infection or increases the risk of adverse outcomes (mortality, risk of hospitalization, risk of mechanical ventilation). Subsequently, international regulatory authorities (World Health Organization, European Medical Agency, FDA) concluded that there is no link between the more severe course of COVID-19 and NSAID treatment; paracetamol and other NSAIDs (ibuprofen) are recommended to treat the symptoms of COVID-19; patients on chronic NSAID treatment are warned not to discontinue it, as their condition may worsen.

About the authors

Marina V. Leonova

Association of Clinical Pharmacologists

Email: anti23@mail.ru
чл.-кор. РАЕН, д-р мед. наук, проф. Volgograd, Russia

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