Use of non-steroidal anti-inflammatory drugs and adverse outcomes during the COVID-19 pandemic: A systematic review and meta-analysis

作者全名："Zhou, Qi; Zhao, Siya; Gan, Lidan; Wang, Zhili; Peng, Shuai; Li, Qinyuan; Liu, Hui; Liu, Xiao; Wang, Zijun; Shi, Qianling; Estill, Janne; Luo, Zhengxiu; Wang, Xiaohui; Liu, Enmei; Chen, Yaolong"

作者地址："[Zhou, Qi; Wang, Zijun; Chen, Yaolong] Lanzhou Univ, Sch Basic Med Sci, Evidence Based Med Ctr, Lanzhou, Peoples R China; [Zhou, Qi; Chen, Yaolong] Lanzhou Univ, Inst Hlth Data Sci, Lanzhou, Peoples R China; [Zhao, Siya; Liu, Hui; Liu, Xiao; Wang, Xiaohui; Chen, Yaolong] Lanzhou Univ, Sch Publ Hlth, Lanzhou, Peoples R China; [Gan, Lidan; Wang, Zhili; Peng, Shuai; Li, Qinyuan; Luo, Zhengxiu; Liu, Enmei] Chongqing Med Univ, Med Childrens, Dept Resp,Key Lab Child Dev & Disorders,Chongqing, Natl Clin Res Ctr Child Hlth & Disorders,Minist E, Chongqing, Peoples R China; [Shi, Qianling] Lanzhou Univ, Sch Clin Med 1, Lanzhou, Peoples R China; [Estill, Janne] Univ Geneva, Inst Global Hlth, Geneva, Switzerland; [Estill, Janne] Univ Bern, Inst Math Stat & Actuarial Sci, Bern, Switzerland; [Chen, Yaolong] WHO Collaborating Ctr Guideline Implementat & Kno, Lanzhou, Switzerland; [Chen, Yaolong] Lanzhou Univ, Sch Basic Med Sci, Chinese Acad Med Sci 2021RU017, Res Unit Evidence Based Evaluat & Guidelines, Lanzhou, Peoples R China"

通信作者："Chen, YL (通讯作者)，Lanzhou Univ, Sch Basic Med Sci, Evidence Based Med Ctr, Lanzhou, Peoples R China.; Wang, XH; Chen, YL (通讯作者)，Lanzhou Univ, Sch Publ Hlth, Lanzhou, Peoples R China.; Liu, EM (通讯作者)，Chongqing Med Univ, Med Childrens, Dept Resp,Key Lab Child Dev & Disorders,Chongqing, Natl Clin Res Ctr Child Hlth & Disorders,Minist E, Chongqing, Peoples R China."

来源：ECLINICALMEDICINE

ESI学科分类：　

WOS号：WOS:000821492000024

JCR分区：Q1

影响因子：15.1

年份：2022

卷号：46

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：NSAIDs; COVID-19; Systematic review; Meta-analysis

摘要："Background There are concerns that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of adverse outcomes among patients with coronavirus COVID-19. This study aimed to synthesize the evidence on associations between the use of NSAIDs and adverse outcomes. Methods A systematic search of WHO COVID-19 Database, Medline, the Cochrane Library, Web of Science, Embase, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Database for all articles published from January 1, 2020, to November 7, 2021, as well as a supplementary search of Google Scholar. We included all comparative studies that enrolled patients who took NSAIDs during the COVID-19 pandemic. Data extraction and quality assessment of methodology of included studies were completed by two reviewers independently. We conducted a meta-analysis on the main adverse outcomes, as well as selected subgroup analyses stratified by the type of NSAID and population (both positive for severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) or not). Findings Forty comparative studies evaluating 4,867,795 adult cases were identified. Twenty-eight (70%) of the included studies enrolled patients positive to SARS-CoV-2 tests. The use of NSAIDs did not reduce mortality outcomes among people with COVID-19 (number of studies [N] = 29, odds ratio [OR] = 0.93, 95% confidence interval [CI]: 0.75 to 1.14, I-2 = 89%). Results suggested that the use of NSAIDs was not significantly associated with higher risk of SARS-CoV-2 infection in patients with or without COVID-19 (N = 10, OR = 0.96, 95% CI: 0.86 to 1.07, I-2 = 78%; N = 8, aOR = 1.01, 95% CI: 0.94 to 1.09, I-2 = 26%), or an increased probability of intensive care unit (ICU) admission (N = 12, OR = 1.28, 95% CI: 0.94 to 1.75, I-2 = 82% ; N = 4, aOR = 0.89, 95% CI: 0.65 to 1.22, I-2 = 60%), requiring mechanical ventilation (N = 11, OR = 1.11, 95% CI: 0.79 to 1.54, I-2 = 63%; N = 5, aOR = 0.80, 95% CI: 0.52 to 1.24, I-2 = 66%), or administration of supplemental oxygen (N = 5, OR = 0.80, 95% CI: 0.52 to 1.24, I-2 = 63%; N = 2, aOR = 1.00, 95% CI: 0.89 to 1.12, I-2 = 0%). The subgroup analysis revealed that, compared with patients not using any NSAIDs, the use of ibuprofen (N = 5, OR = 1.09, 95% CI: 0.50 to 2.39; N = 4, aOR = 0.95, 95% CI: 0.78 to 1.16) and COX-2 inhibitor (N = 4, OR = 0.62, 95% CI: 0.35 to 1.11; N = 2, aOR = 0.73, 95% CI: 0.45 to 1.18) were not associated with an increased risk of death. Interpretation Data suggests that NSAIDs such as ibuprofen, aspirin and COX-2 inhibitor, can be used safely among patients positive to SARS-CoV-2. However, for some of the analyses the number of studies were limited and the quality of evidence was overall low, therefore more research is needed to corroborate these findings. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd."

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