Study reinforces that ibuprofen does not make COVID worse

Matt Woodley

10/09/2020 4:21:37 PM

New analysis provides ‘further strength’ to the recommendation that it is safe to treat mild symptoms with ibuprofen.

Ibuprofen packet
Australia’s National COVID-19 Clinical Evidence Taskforce recommends the use of ibuprofen and paracetamol as appropriate for symptomatic relief in mild cases.

The University of Southern Denmark researchers who authored the study formed their conclusion by analysing the clinical outcomes of 9326 Danes who had COVID-19, 248 of whom were taking non-steroidal anti-inflammatory drugs (NSAIDs).
The analysis found no difference in the severity of coronavirus symptoms between the two groups, despite concerns early in the pandemic that ibuprofen might make COVID-19 worse.
Dr Evan Ackermann, immediate past Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP that while it is possible ‘certain, yet to be identified sub-populations’ may have issues taking NSAIDs, the new study provides reassuring evidence on its safe use in early COVID disease.
‘The original concern was hypothetical, but given credibility because the WHO [World Health Organization] and French authorities repeated these concerns publicly,’ he said.
‘It was at the height of COVID spread [and] at the time I didn’t feel it had much weight.
‘GPs would prescribe NSAIDS on the balance of the benefit or risks in each patient profile. I do not think this would change just because they have COVID.
‘I am sure most GPs are also vigilant in watching therapeutic updates relevant to the disease.’
While the WHO initially recommended people with COVID-19 avoid taking ibuprofen for symptomatic relief – before retracting that advice days later – a group of scientists and clinicians backed the warning from the French Health Minister.
Some also harboured concerns that ibuprofen may increase a person’s chance of developing COVID-19 due to its effect on angiotensin-converting enzyme 2 (ACE-2) receptors.
However, Australia’s National COVID-19 Clinical Evidence Taskforce has continually recommended the use of paracetamol or ibuprofen as appropriate for symptomatic relief in mild cases.
Professor Mark Morgan, co-chair of the primary and chronic care expert panel for the Taskforce, told newsGP the group has never supported the ‘very shaky theoretical possibility’ of NSAIDs increasing COVID-19 severity.
‘We haven’t bought into that because it didn’t translate into any clinical evidence,’ he said. ‘This big data approach taken by the researchers is really further evidence and adds further strength to the recommendation to treat the symptoms of mild COVID with paracetamol or ibuprofen.
‘Some people can’t take anti-inflammatories, but for the people that [can] it’s safe to prescribe and it’s a reasonable choice for the management of COVID symptoms.’
However, the findings remain important for general practice given GPs care for the vast majority of mild COVID cases in Australia.
‘Four out of five people will have a mild course of COVID, so they won’t need to be looked after in a hospital setting,’ Professor Morgan said.
‘There are some states still doing the hospital-in-the-home setting for those people as a mechanism of monitoring their progress, but it really is within the remit of general practice to look after people with mild disease.’
Professor Morgan said the research also serves as an important reminder to rely on trusted sources of information supported by strong evidence.
‘We’ve seen a tremendous lot of people, and quite often not people who have particular expertise in the area, jumping on media releases where the evidence hasn’t been presented,’ he said. ‘That’s clearly wrong.
‘It has happened time and again during the pandemic – people jumping on particular bandwagons – and it’s really hard to know sometimes what the motivation is for doing that.
‘You’re seeing it happen with people advising the use of plasma, or people advising the use of all those treatments that when you look in the national clinical evidence taskforce guidelines are listed as “do not use unless it’s part of a clinical trial”.
‘[Such a listing] is really a very clear indication that we’ve looked closely at the evidence and not found enough to make a clinical decision to use a treatment, especially a harmful treatment.
‘It’s the same with stopping or avoiding use of a treatment that that’s likely to be beneficial. You don’t stop doing something normally beneficial unless you’ve got some pretty clear evidence to suggest you should be stopping.’
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Dr Peter James Strickland   11/09/2020 1:31:53 PM

I would like the RACGP concentrate on getting now researched and proven treatments back in the "middle arena". To have hyrdoxyhloroquine +zinc, and ivermectin+zinc on the back burner, and the former illegal to prescribe is an indictment of the Premiers pushing this line, and the lack of positive action on behalf the medical profession by the AMA and RACGP, and other Colleges. The use of these medications early in the disease attenuation of Covid 19 in the elderly in the USA is now out and about. We need to get on with telling these Premiers to get their act together, and start the proper management of this disease in an ethical and scientific way, and NOT by arbitrary lockdown decisions as we have seen in Victoria, and which ARE not related to health and welfare, but simply controlling the lives of people and their work, play and mental health. This whole thing in Victoria and Qld is a disgrace, and now reached the state of dictatorship. I would sack all the Chief Health Officers!

Dr Rodney Paul Jones   14/09/2020 12:34:15 PM

How was the Danish study funded?