Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
Ann Rheum Dis. 2021 Jul;80(7):943-951. doi: 10.1136/annrheumdis-2020-219517. Epub 2021 Jan 21.
To assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform.
We conducted two cohort studies from 1 March to 14 June 2020. Working on behalf of National Health Service England, we used routine clinical data in England linked to death data. In study 1, we identified people with an NSAID prescription in the last 3 years from the general population. In study 2, we identified people with rheumatoid arthritis/osteoarthritis. We defined exposure as current NSAID prescription within the 4 months before 1 March 2020. We used Cox regression to estimate HRs for COVID-19 related death in people currently prescribed NSAIDs, compared with those not currently prescribed NSAIDs, accounting for age, sex, comorbidities, other medications and geographical region.
In study 1, we included 536 423 current NSAID users and 1 927 284 non-users in the general population. We observed no evidence of difference in risk of COVID-19 related death associated with current use (HR 0.96, 95% CI 0.80 to 1.14) in the multivariable-adjusted model. In study 2, we included 1 708 781 people with rheumatoid arthritis/osteoarthritis, of whom 175 495 (10%) were current NSAID users. In the multivariable-adjusted model, we observed a lower risk of COVID-19 related death (HR 0.78, 95% CI 0.64 to 0.94) associated with current use of NSAID versus non-use.
We found no evidence of a harmful effect of routinely prescribed NSAIDs on COVID-19 related deaths. Risks of COVID-19 do not need to influence decisions about the routine therapeutic use of NSAIDs.
利用安全分析平台 OpenSAFELY 评估常规处方的非甾体抗炎药（NSAIDs）与 COVID-19 死亡之间的关联。
我们于 2020 年 3 月 1 日至 6 月 14 日进行了两项队列研究。代表英国国民保健署（NHS），我们使用英格兰常规临床数据与死亡数据进行关联。在研究 1 中，我们从一般人群中确定了过去 3 年内有 NSAID 处方的人群。在研究 2 中，我们确定了患有类风湿关节炎/骨关节炎的人群。我们将暴露定义为在 2020 年 3 月 1 日前的 4 个月内有当前 NSAID 处方。我们使用 Cox 回归估计当前处方 NSAIDs 与未处方 NSAIDs 的 COVID-19 相关死亡的 HR，同时考虑年龄、性别、合并症、其他药物和地理位置。
在研究 1 中，我们纳入了 536423 名当前 NSAID 使用者和 1927284 名一般人群中的非使用者。在多变量调整模型中，我们没有发现当前使用 NSAIDs 与 COVID-19 相关死亡风险相关的差异（HR 0.96，95%CI 0.80 至 1.14）。在研究 2 中，我们纳入了 1708781 名患有类风湿关节炎/骨关节炎的患者，其中 175495 名（10%）为当前 NSAID 使用者。在多变量调整模型中，与非使用者相比，当前使用 NSAID 与 COVID-19 相关死亡风险降低（HR 0.78，95%CI 0.64 至 0.94）。
我们没有发现常规处方 NSAIDs 与 COVID-19 相关死亡之间存在有害影响的证据。COVID-19 的风险不需要影响 NSAIDs 的常规治疗使用决策。
