A recent paper published in The Lancet Respiratory Medicine has led to a debate over whether or not people with COVID-19 should take ibuprofen and other NSAIDs.
WHO spokesperson Christian Lindmeier told reporters that U.N. health officials are “looking into this to give further guidance,” according to an article in ScienceAlert.
“In the meantime, we recommend using [instead] paracetamol, and do not use ibuprofen as a self-medication,” he said. “That's important.”
WHO later reversed this advice in a tweet, stating it does “not recommend against the use of ibuprofen.”
The Lancet paper, which investigated whether people with diabetes and hypertension are at an increased risk for COVID-19 infection, explained that human pathogenic coronaviruses bind target cells together using angiotensin-converting enzyme 2 (ACE2), which can be increased by treatment with ACE inhibitors and angiotensin II type-I receptor blockers.
The authors also stated that thiazolidinediones and ibuprofen can increase ACE2.
“Consequently, the increased expression of ACE2 would facilitate infection with COVID-19,” Lei Fang, MD, PhD, postdoctoral researcher in the department of biomedicine at University Hospital Basel, Switzerland, and colleagues wrote. “We therefore hypothesize that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.”
In response to the paper, Olivier Véran, the French Minister for Solidarity and Health, tweeted that ibuprofen and other NSAIDs can worsen COVID-19 infection.
In addition, the French government recommended that paracetamol, also known as acetaminophen, be used in patients with COVID-19 and stated that NSAIDs should not.
However, Angela L. Rasmussen, PhD, an associate research scientist at the Columbia University Mailman School of Public Health Center for Infection and Immunity, told Healio Primary Care that “there is no current evidence that ibuprofen specifically impacts COVID-19 disease severity.”
In a recent statement, the FDA said it is “not aware of scientific evidence connecting the use of NSAIDs, like ibuprofen, with worsening COVID-19 symptoms.”
However, the agency also cautioned that all labels for prescription NSAIDs warn that “the pharmacological activity of NSAIDs in reducing inflammation, and possibly fever, may diminish the utility of diagnostic signs in detecting infections.”
Like WHO, the FDA added that it will be investigating the issue further.
The European Medicines Agency (EMA) also stated that there is no scientific evidence linking ibuprofen and worsened COVID-19.
The organization noted that it previously completed a safety review of ibuprofen and ketoprofen after survey results suggested that the drugs may worsen varicella and other bacterial infections. EMA officials suggested that further studies are needed to determine if there are associations between NSAIDs and COVID-19 prognosis.
“When starting treatment for fever or pain in COVID-19, patients and health care professionals should consider all available treatment options including paracetamol and NSAIDs,” the organization stated in the release.
Patients should contact their physicians or pharmacists with questions, but the EMA stated that based on current evidence, “there is currently no reason for patients taking ibuprofen to interrupt their treatment.”
Carlos del Rio, MD, FIDSA, executive associate dean at Emory University School of Medicine, told Healio Primary Care that infectious disease researchers “are both implementing aggressive measures to mitigate the epidemic, but are also involved in research that will help us learn a lot of the current many unknowns of this virus.” – by Erin Michael and Janel Miller
Editor’s note: This story has been updated to include information from the FDA, del Rio and WHO.
DGS-urgent. Covid 19 recommendations update. https://dgs-urgent.sante.gouv.fr/dgsurgent/inter/detailsMessageBuilder.do?id=30500&cmd=visualiserMessage. Accessed March 18, 2020.
EMA. EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19. https://www.ema.europa.eu/en/news/ema-gives-advice-use-non-steroidal-anti-inflammatories-covid-19. Accessed March 18, 2020.
Fang L, et al. Lancet Respir Med. 2020;doi:10.1016/S2213-2600(20)30116-8.
FDA. FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19. https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19. Accessed March 20, 2020.
Twitter. Olivier Véran. https://twitter.com/olivierveran/status/1238776545398923264. Accessed March 18, 2020.
Disclosures: Fang and Rasmussen report no relevant financial disclosures. Healio Primary Care was unable to confirm Véran’s relevant financial disclosures at the time of publication.