Ibuprofen and other anti-inflammatory painkillers could make hospital patients with coronavirus more likely to die, according to a study.
South Korean research looking at deaths and complications in Covid-19 patients suggested the common painkiller drugs raised the risk of death by 65 per cent.
And the non-steroidal anti-inflammatory drugs (NSAIDs) may push up the risk of serious heart or kidney complications by 85 per cent, results showed.
NSAIDs are common and some types — including ibuprofen and naproxen — can be bought over-the-counter for pennies. High-dose aspirin is also included in the category but was not counted in the study.
The drugs are often used to relieve the pain caused by headaches, periods, muscle injuries, cold and flu, and arthritis.
Researchers behind the study said anti-inflammatories should be ‘used with caution’ in coronavirus patients and called on more trials to prove the link.
This is not the first time research has suggested a link to worsening Covid-19 but the NHS says there is ‘no clear evidence’ that NSAIDs are dangerous. It says it is safe for people to take ibuprofen if they have coronavirus symptoms.
The NHS says there is still ‘no clear evidence’ that ibuprofen or other NSAIDs are dangerous for people with the coronavirus and says people can take them to reduce symptoms if they want to (stock image)
Scientists at the Sungkyunkwan University in Seoul, South Korea, studied a total of 1,824 hospital patients who had Covid-19.
They found people who had had a prescription for NSAIDs in the seven days before joining the study were more likely to die of coronavirus.
It is not clear whether all the patients were being prescribed the NSAIDs before entering hospital or while in hospital but before the study enrolled them.
Prescription drugs could be stronger than shop-bought ones, but it could also be the case that inpatients were being prescribed regular medicines by hospital doctors.
Those taking the drugs were also more likely to experience serious problems with their heart or kidneys.
Led by PhD student Han Eol Jeong, they wrote: ‘Use of NSAIDs, compared with non-use, is associated with worse outcomes among hospitalised Covid-19 patients.
‘While awaiting the results of confirmatory studies, we suggest NSAIDs be used with caution among patients with Covid-19.’
The team added: ‘The harms associated with their use may outweigh their benefits in this population.’
Mr Jeong and colleagues suggested the way the common drugs worsen the disease is by forcing the body to allow more of the viruses to attack it.
They said studies in animals had found NSAIDs appear to increase the amount of a specific receptor inside the body, known as an ACE-2 receptor, which is effectively the doorman that allows the coronavirus into the body.
These ACE-2 receptors are a normal part of the body and are found mostly in the airways and blood vessels — but they are known to be the gateway through which the coronavirus causes infection.
On the NHS website’s page about non-steroidal anti-inflammatory drugs (NSAIDs) the health service says there is ‘no clear evidence’ that taking the medicines can make coronavirus worse, and says people can take them if they have symptoms of the disease (Screenshot from June 17 2020)
Increasing the amount of them, which the scientists suggest NSAIDs do, could offer the coronavirus more ways into the body and allow it to mount a stronger attack.
The researchers said: ‘ACE-2 upregulation induced by NSAIDs could theoretically heighten the infectivity of SARS-CoV-2 to worsen clinical outcomes, resulting in multiple organ failure in severe cases.’
They added that it was also possible the drugs weakened the immune system but there was not strong evidence for this.
In the study, 354 out of the total 1,824 Covid-19 patients were considered anti-inflammatory users (19 per cent) and 1,470 (81 per cent) were non-users.
Out of all the patients, 76 of them either died, went into intensive care or got sepsis — or experienced more than one of those.
A disproportionate amount of the seriously ill patients were NSAID users, the study found — 6.5 per cent of them became seriously ill or died (23 out of 354), compared to 3.6 per cent of the people who didn’t take the drugs (53 out of 1,470).
There were also a disproportionate amount of people taking NSAIDs in the group that developed serious heart or kidney problems while they were in hospital.
Of 44 who developed those complications, 28 were patients taking NSAIDs and 16 were not. The risk was 87 per cent higher, the researchers said.
Their study did not show which types of NSAIDs the worst-affected patients were taking. It included the following under its NSAID definition: aceclofenac, diclofenac, etodolac, fenoprofen, flurbiprofen, dexibuprofen, ibuprofen, ibuproxam, ketoprofen, dexketoprofen, ketorolac, meloxicam, naproxen, piroxicam, celecoxib, polmacoxib, and etoricoxib.
The NHS still recommends people take ibuprofen if they have a fever caused by Covid-19 and says there is ‘no clear evidence’ that it can be harmful.
There was a scare in March when the health service removed ibuprofen from its recommended self-treatments and the UK’s chief scientist, Sir Patrick Vallance, said it would be ‘sensible’ to avoid the drug in light of concerns about its safety.
French health minister Olivier Véran brought the issue to the fore when he said anti-inflammatories could ‘aggravate the infection’.
Other leading medics echoed his concerns, admitting the drug could dampen the immune system and even slow down recovery.
But scientists at King’s College London then reviewed 13 other studies into the effects of NSAIDs on coronavirus patients and found no evidence it was risky.
That study, led by Dr Beth Russell, said: ‘Since the outbreak of the novel COVID-19 infection, various contradictory information has been circulated regarding the potentially negative effect of treating patients with NSAIDs.
‘Our search did not identify any strong evidence for or against the use of ibuprofen for treatment of COVID-19 specifically.
‘The current literature does not give conclusive evidence for or against the use of NSAIDs in the treatment of COVID-19 patients.’
The NHS has since reinstated the advice on its website for people to use ibuprofen to reduce symptoms of Covid-19 if they feel ill, but to try paracetamol first.
Its website reads: ‘There have been some news reports of anti-inflammatory painkillers, such as ibuprofen, making coronavirus worse.
‘The Commission on Human Medicines has now confirmed there is no clear evidence that using ibuprofen to treat symptoms such as a high temperature makes coronavirus worse.
‘You can take paracetamol or ibuprofen to treat symptoms of coronavirus. Try paracetamol first if you can, as it has fewer side effects than ibuprofen and is the safer choice for most people.’
The Sungkyunkwan University study has not been reviewed by other scientists or published in a journal but was posted on the research-sharing website medRxiv.