The content of this evidence review was up to date on 20 April 2020. New evidence may have been published since then. See summaries of product characteristics (SPCs), British national formulary (BNF) or the MHRA or NICE websites for up-to-date prescribing 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, NHS England issued a Central Alerting System (CAS) alert, in which the Medical Director, Professor Stephen Powis, gave interim advice that people who are currently on NSAIDs for medical reasons (such as arthritis) should not stop them and advised that the MHRA and NICE would review this topic.
NICE has produced an evidence review on acute NSAID use for COVID-19, which informed a subsequent NHS England and NHS Improvement policy statement. The policy states that, when patients, carers or healthcare professionals are starting treatment for fever and/or pain in adults or children with confirmed or suspected COVID‑19, all treatment options should be considered and selected based on the greatest benefit compared to potential harms using each medicine's product information (see the NICE COVID‑19 guideline on managing symptoms (including at end of life) in the community).
A proportion of people taking long-term NSAIDs for other conditions may be at higher risk of developing COVID‑19 or more severe COVID‑19 because of their chronic condition or concomitant medication; for example, people with rheumatoid arthritis taking immunosuppressants.
The purpose of this review is to assess the best available evidence to determine:
If long-term use of NSAIDs is associated with an increased risk of developing COVID‑19.
If long-term use of NSAIDs is associated with an increased risk of developing more severe COVID‑19.
For the purposes of this evidence review, long-term use of NSAIDs is defined as a regular, moderate dose of NSAIDs for at least 2 weeks, normally for chronic conditions.
A literature search identified 173 references, which were screened using their titles and abstracts. Thirteen references were obtained in full text and assessed for relevance; however, none were suitable for inclusion. This means that no evidence from published scientific studies was found to determine whether long-term use of NSAIDs is related to increased risk of developing COVID‑19 or increased risk of more severe COVID‑19.
There is no evidence to suggest that people taking NSAIDs for a long-term condition should be advised to stop treatment in the context of COVID‑19. Gastrointestinal, respiratory, cardiovascular and renal adverse effects are listed among the possible adverse effects of NSAIDs in the BNF. COVID‑19 may also lead to respiratory, cardiovascular and renal complications (BMJ Best Practice). In addition, certain comorbidities (such as diabetes, hypertension, cardiovascular disease and chronic respiratory disease) increase the risk of more severe COVID‑19 (The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team 2020).