Pain Relief from NSAIDS and COVID-19 Outcomes

PainRelief.com Interview with:
Anton Pottegård DMSc PhD

Professor (MScPharm, PhD, DMSc)
Clinical Pharmacology and Pharmacy, Department of Public Health
University of Southern Denmark
Head of Research, Hospital Pharmacy Funen
Odense University Hospital

PainRelief.com:  What is the background for this study?

Response: Early in the COVID-19 pandemic, concerns were raised that use of the common painkiller ibuprofen – a so-called NSAID – to treat symptoms of COVID-19 might lead to more severe disease. This started with tweets from the French health minister and culminated with a warning issued by the WHO. This warning was later retracted, but naturally patients and physicians were concerned regarding the safety of ibuprofen. We therefore established a nationwide Danish collaboration between researchers and regulators and established a prospective cohort of all Danish patients that contracted COVID-19, including data on what prescription medicines they used. We used these data to evaluate whether users of ibuprofen or other NSAIDs on average had a more severe course of COVID-19 than those not using these drugs.

PainRelief.com: What are the main findings?

Response: Overall, use of ibuprofen and other NSAIDs does not seem to influence the risk of severe outcomes with COVID-19. This includes similar risks of being hospitalized, having to go the ICU, receive mechanical ventilation or death when compared to non-users of these drugs. This provides assurance for the many users of these drugs.

PainRelief.com: What should readers take away from your report?

Response: The general recommendation is that use of ibuprofen and other NSAIDs should be limited to the lowest useable dose and the shortest possible duration. This is due to a range of other side-effects. However, on the basis of our study, it does not seem that otherwise effective and well-indicated use of these drugs should be stopped over fear of COVID-19 complications.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: There are very few places on the globe were a study like ours can be carried out. This mainly has to do with the use of over-the-counter ibuprofen. In Denmark, over-the-counter use is very limited. In most other countries, however, the majority of ibuprofen is obtained over-the-counter, which makes it immensely difficult to study, as there is no longer data that can link the use of the drug to the individual patient. I therefore doubt that other large-scale observational studies will emerge on the same hypothesis.

PainRelief.com: Is there anything else you would like to add?

Response: On a more personal note, this study to me exemplifies one of the COVID-19-induced realizations that us humans really can do a lot if we work together. The study was conducted with good colleagues from Aarhus University Hospital, the Danish Medicines Agency, and Statens Serum Institut. This collaboration was set up over a very short period of time, with everyone dropping whatever they were doing to help each other to complete this study, as well as other studies in our pipeline. Our collaboration with other academic centers, regulators, and clinicians have always been very important to me and formed the basis of many important realizations. This trying period have propelled our collaboration onto a new level, something I hope in the coming years will benefit our research and thus ultimately the patients.

Citation:

Lars Christian Lund, Kasper Bruun Kristensen, Mette Reilev, Steffen Christensen, Reimar Wernich Thomsen, Christian Fynbo Christiansen, Henrik Støvring, Nanna Borup Johansen, Nikolai Constantin Brun, Jesper Hallas, Anton Pottegård. Adverse outcomes and mortality in users of non-steroidal anti-inflammatory drugs who tested positive for SARS-CoV-2: A Danish nationwide cohort study. PLOS Medicine, 2020; 17 (9): e1003308 DOI: 10.1371/journal.pmed.1003308

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