Non-steroidal anti-inflammatory drugs and susceptibility to COVID-19

Objectives To identify whether active use of non-steroidal anti-inflammatory drugs (NSAIDs) increases susceptibility to developing suspected or confirmed COVID-19 compared to the use of other common analgesics. Methods We performed a propensity score-matched cohort study with active comparators using a large UK primary care dataset. The cohort consisted of adult patients aged ≥18 years with a diagnosis of osteoarthritis and followed up from 30th January to 31st July 2020. Patients prescribed an NSAID (excluding topical preparations) were compared to those prescribed either co-codamol (paracetamol and codeine) or co-dydramol (paracetamol and dihydrocodeine). We identified 13,202 patients prescribed NSAIDs compared to 12,457 prescribed the comparator drugs. The primary outcome was documentation of suspected or confirmed COVID-19 and secondary outcome measure was all-cause mortality. Results During follow up, the incidence rates of suspected/confirmed COVID-19 were 15.4 and 19.9 per 1000 person-years in the NSAID-exposed and comparator groups, respectively. Adjusted hazard ratios in the unmatched and propensity score matched analyses for primary care consultations with suspected/confirmed COVID-19 were 0.82 (95% CI 0.62-1.10) and 0.79 (95% CI 0.57-1.11) respectively, and for subsequent mortality were 0.97 (95% CI 0.75-1.27) and 0.85 (95% CI 0.61-1.20). There was no effect modification by age or sex. Conclusion We did not observe an increased risk of suspected or confirmed COVID-19 or mortality among patients in primary care with osteoarthritis who were prescribed NSAIDs compared to comparator drugs. These results are reassuring and suggest that in the absence of acute illness, NSAIDs can be safely prescribed during the ongoing pandemic.