Key messages

The content of this evidence review was up-to-date on 24 March 2020. See summaries of product characteristics (SPCs), British national formulary (BNF) or the MHRA or NICE websites for up-to-date information.

In March 2020, the French Health Ministry issued advice to avoid using non-steroidal anti-inflammatory drugs (NSAIDs) to treat symptoms of COVID-19 because these medicines might aggravate the infection. In response to these concerns, the MHRA issued a Central alerting system (CAS) alert in which the NHS England Medical Director, Professor Stephen Powis, advised using paracetamol in preference to ibuprofen in people with confirmed or suspected COVID-19, while acknowledging there is limited evidence that ibuprofen is either safe or harmful in these people. In view of the current lack of clarity the Commission on Human Medicines (an advisory body of the MHRA) and NICE were asked to review the evidence.

The purpose of this review is to assess the best available evidence to determine:

  • If there is any increased risk of developing COVID-19 due to acute use of NSAIDs.

  • If acute use of NSAIDs can lead to an increased risk of developing more severe symptoms of COVID-19.

This review does not consider people who are taking NSAIDs long-term for existing chronic conditions.

A literature search identified 156 references, which were screened using their titles and abstracts. Thirteen references were obtained and assessed for relevance; however, none were suitable for inclusion. This means that no evidence from published scientific studies was found to determine whether acute use of NSAIDs is related to increased risk of developing COVID-19 or increased risk of a more severe illness.

The available evidence suggests that, although the anti-inflammatory effects of NSAIDs reduce acute symptoms (such as fever), they may either have no effect on, or worsen, long-term outcomes, possibly by masking symptoms of worsening acute respiratory tract infection. Further evidence is needed to confirm this, and to determine whether these results also apply to infections such as COVID-19.

Likely place in therapy

NHS England has developed a commissioning policy for acute use of NSAIDs for people with or at risk of COVID-19.