In a cohort of COVID-19 patients, ibuprofen was not found to be associated with worse clinical outcomes compared with paracetamol or no antipyretic, according to data published in Clinical Microbiology and Infection.
Early in the coronavirus disease 2019 (COVID-19) epidemic, it was suggested that ibuprofen might increase the risk for severe or fatal COVID-19 disease. A team of investigators therefore evaluated whether ibuprofen use in patients with COVID-19 was associated with increased severity of disease compared with patients using acetaminophen or no antipyretics.
Ibuprofen use was monitored from 1 week prior to diagnosis of COVID-19 throughout the disease in 403 patients with a median age of 45 years. Within the cohort, 11% of patients needed respiratory and 3% died. Fever occurred in 44% of patients, with 32% using an acetaminophen product and 22% using ibuprofen for symptom relief. Within the ibuprofen group, 3.4% of patients died; 2.8% patients in the non-ibuprofen group died (P= .95). Respiratory support was required in 10.3% of ibuprofen patients and 11% of non-ibuprofen users (P=1.0). No differences were observed in mortality rates or need for respiratory support when ibuprofen was compared with acetaminophen exclusively.
The investigators note several study limitations, including the potential for recall bias in a retrospective study. However, this should be less of a concern given the short time frame of the study, and the investigators do not believe this limitation would favor one treatment over the other. Also, medical information for deceased patients was only available from medical chart review. Sample size was also not sufficient to allow multivariable analyses. During the outset of the COVID-19 epidemic, the policy of the governing body in the country where the study was conducted (Israel) was to test only patients with symptoms that are suggestive of COVID-19; therefore, no data on use of ibuprofen in asymptomatic carriers were available. The study was strengthened by a high response rate and nearly complete follow-up.
The investigators conclude that in their cohort, the claim that ibuprofen is unsafe for use in patients with COVID-19 symptoms was not supported. However, they suggest that larger prospective studies are needed to validate these results.
Rinott E, Kozer E, Shapira Y, Bar-Haim A, Youngster I. Ibuprofen use and clinical outcomes in COVID-19 patients [published online June, 11 2020]. Clin Microbiol Infect. doi:10.1016/j.cmi.2020.06.003