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The COVID‐19 ibuprofen controversy: A systematic review of NSAIDs in adult acute lower respiratory tract infections
Author(s) -
Vaja Ricky,
Chan Jeffrey Shi Kai,
Ferreira Plinio,
Harky Amer,
Rogers Luke J.,
Gashaw Hime H.,
Kirkby Nicholas S.,
Mitchell Jane A.
Publication year - 2021
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.14514
Subject(s) - medicine , respiratory tract infections , observational study , pneumonia , bronchitis , intensive care medicine , lower respiratory tract infection , clinical trial , chronic bronchitis , respiratory system
Aims In light of the recent safety concerns relating to NSAID use in COVID‐19, we sought to evaluate cardiovascular and respiratory complications in patients taking NSAIDs during acute lower respiratory tract infections. Methods We carried out a systematic review of randomised controlled trials and observational studies. Studies of adult patients with short‐term NSAID use during acute lower respiratory tract infections, including bacterial and viral infections, were included. Primary outcome was all‐cause mortality. Secondary outcomes were cardiovascular, renal and respiratory complications. Results In total, eight studies including two randomised controlled trials, three retrospective and three prospective observational studies enrolling 44 140 patients were included. Five of the studies were in patients with pneumonia, two in patients with influenza, and one in a patient with acute bronchitis. Meta‐analysis was not possible due to significant heterogeneity. There was a trend towards a reduction in mortality and an increase in pleuro‐pulmonary complications. However, all studies exhibited high risks of bias, primarily due to lack of adjustment for confounding variables. Cardiovascular outcomes were not reported by any of the included studies. Conclusion In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro‐pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution. Mechanistic and clinical studies addressing the captioned subject are urgently needed, especially in relation to COVID‐19.