Department of Anesthesiology, Third Hospital of Nanchang, Jiangxi, China.
Department of Endocrine, Second Affiliated Hospital of Nanchang University, Jiangxi, China.
Br J Clin Pharmacol. 2022 Dec;88(12):5113-5127. doi: 10.1111/bcp.15512. Epub 2022 Sep 20.
Recent reports of potential harmful effects of nonsteroidal anti-inflammatory drugs (NSAIDs) in treating patients with coronavirus disease 2019 (COVID-19) have raised great concern.
We searched the PubMed, EMBASE, Cochrane Library and MedRxiv databases to examine the prevalence of NSAID use and associated COVID-19 risk, outcomes and safety.
Twenty-five studies with a total of 101 215 COVID-19 patients were included. Prevalence of NSAID use among COVID-19 patients was 19% (95% confidence interval [CI] 14-23%, no. of studies [n] = 22) and NSAID use prior to admission or diagnosis of COVID-19 was not associated with an increased risk of COVID-19 (adjusted odds ratio [aOR] = 0.93, 95% CI 0.82-1.06, I = 34%, n = 3), hospitalization (aOR = 1.06, 95% CI 0.76-1.48, I = 81%, n = 5), mechanical ventilation (aOR = 0.71, 95% CI 0.47-1.06, I = 38%, n = 4) or length of hospital stay. Moreover, prior use of NSAIDs was associated with a decreased risk of severe COVID-19 (aOR = 0.79, 95% CI 0.71-0.89, I = 0%, n = 7) and death (aOR = 0.68, 95% CI 0.52-0.89, I = 85%, n = 10). Prior NSAID administration might also be associated with an increased risk of stroke (aOR = 2.32, 95% CI 1.04-5.2, I = 0%, n = 2), but not myocardial infarction (aOR = 1.49, 95% CI 0.25-8.92, I = 0, n = 2) and composite thrombotic events (aOR = 1.56, 95% CI 0.66-3.69, I = 52%, n = 2).
Based on current evidence, NSAID use prior to admission or diagnosis of COVID-19 was not linked with increased odds or exacerbation of COVID-19. NSAIDs might provide a survival benefit, although they might potentially increase the risk of stroke. Controlled trials are still required to further assess the clinical benefit and safety (e.g., stroke and acute renal failure) of NSAIDs in treating patients with COVID-19.
最近有报道称，非甾体抗炎药（NSAIDs）在治疗 2019 年冠状病毒病（COVID-19）患者时可能存在潜在的有害影响，这引起了极大的关注。
我们检索了 PubMed、EMBASE、Cochrane 图书馆和 MedRxiv 数据库，以研究 NSAID 使用与 COVID-19 风险、结局和安全性的相关性。
共纳入 25 项研究，总计 101215 例 COVID-19 患者。COVID-19 患者中 NSAID 使用的流行率为 19%（95%置信区间[CI] 14-23%，研究数量[n] = 22），入院或 COVID-19 诊断前 NSAID 使用与 COVID-19 风险增加无关（调整后的优势比[aOR] = 0.93，95%CI 0.82-1.06，I = 34%，n = 3）、住院（aOR = 1.06，95%CI 0.76-1.48，I = 81%，n = 5）、机械通气（aOR = 0.71，95%CI 0.47-1.06，I = 38%，n = 4）或住院时间。此外，先前使用 NSAIDs 与严重 COVID-19 风险降低相关（aOR = 0.79，95%CI 0.71-0.89，I = 0%，n = 7）和死亡（aOR = 0.68，95%CI 0.52-0.89，I = 85%，n = 10）。先前的 NSAID 给药也可能与中风风险增加相关（aOR = 2.32，95%CI 1.04-5.2，I = 0%，n = 2），但与心肌梗死（aOR = 1.49，95%CI 0.25-8.92，I = 0%，n = 2）和复合血栓事件（aOR = 1.56，95%CI 0.66-3.69，I = 52%，n = 2）无关。
根据目前的证据，入院或诊断 COVID-19 之前使用 NSAIDs 与 COVID-19 风险增加或恶化无关。虽然 NSAIDs 可能提供生存获益，但它们可能会增加中风的风险。仍需要对照试验来进一步评估 NSAIDs 在治疗 COVID-19 患者中的临床获益和安全性（例如中风和急性肾损伤）。
