OpenSAFELY: Do adults prescribed non-steroidal anti-inflammatory drugs have an increased risk of death from COVID-19?
;
Brian MacKenna ;
Caroline E Morton ;
Anna Schultze ;
Alex J Walker ;
Krishnan Bhaskaran ;
Jeremy P Brown ;
Christopher T Rentsch ;
Elizabeth Williamson ;
Henry Drysdale;
+21 more...
Richard Croker ;
Seb Bacon ;
William Hulme;
Chris Bates ;
Helen J Curtis ;
Amir Mehrkar;
David Evans;
Peter Inglesby;
Jonathan Cockburn;
Helen I McDonald ;
Laurie Tomlinson ;
Rohini Mathur ;
Kevin Wing ;
Harriet Forbes ;
John Parry;
Frank Hester;
Sam Harper;
Stephen JW Evans ;
Liam Smeeth ;
Ian J Douglas ;
Ben Goldacre ;
(2020)
OpenSAFELY: Do adults prescribed non-steroidal anti-inflammatory drugs have an increased risk of death from COVID-19?
medRxiv preprint.
2020.08.12.20171405-.
DOI: 10.1101/2020.08.12.20171405
<jats:title>Abstract</jats:title><jats:sec><jats:title>Importance</jats:title><jats:p>There has been speculation that non-steroidal anti-inflammatory drugs (NSAIDs) may negatively affect coronavirus disease 2019 (COVID-19) outcomes, yet clinical evidence is limited.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To assess the association between NSAID use and deaths from COVID-19 using OpenSAFELY, a secure analytical platform.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Two cohort studies (1<jats:sup>st</jats:sup> March-14<jats:sup>th</jats:sup> June 2020).</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Working on behalf of NHS England, we used routine clinical data from >17 million patients in England linked to death data from the Office for National Statistics.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Study 1: General population (people with an NSAID prescription in the last three years). Study 2: people with rheumatoid arthritis/osteoarthritis.</jats:p></jats:sec><jats:sec><jats:title>Exposures</jats:title><jats:p>Current NSAID prescription within the 4 months before 1<jats:sup>st</jats:sup> March 2020.</jats:p></jats:sec><jats:sec><jats:title>Main Outcome and Measure</jats:title><jats:p>We used Cox regression to estimate hazard ratios (HRs) for COVID-19 related death in people currently prescribed NSAIDs, compared with those not currently prescribed NSAIDs, adjusting for age, sex, comorbidities and other medications.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In Study 1, we included 535,519 current NSAID users and 1,924,095 non-users in the general population. The crude HR for current use was 1.25 (95% CI, 1.07–1.46), versus non-use. We observed no evidence of difference in risk of COVID-19 related death associated with current use (HR, 0.95, 95% CI, 0.80–1.13) in the fully adjusted model.</jats:p><jats:p>In Study 2, we included 1,711,052 people with rheumatoid arthritis/osteoarthritis, of whom 175,631 (10%) were current NSAID users. The crude HR for current use was 0.43 (95% CI, 0.36–0.52), versus non-use. In the fully adjusted model, we observed a lower risk of COVID-19 related death (HR, 0.78, 95% CI, 0.65–0.94) associated with current use of NSAID versus non-use.</jats:p></jats:sec><jats:sec><jats:title>Conclusion and Relevance</jats:title><jats:p>We found no evidence of a harmful effect of NSAIDs on COVID-19 related deaths. Risks of COVID-19 do not need to influence decisions about therapeutic use of NSAIDs.</jats:p></jats:sec>
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