NSAID Use Not Associated With Increased Death, ICU Admission in Influenza

Patients who were hospitalized with influenza and were taking a nonsteroidal anti-inflammatory (NSAID) medication had no increased risk of intensive care unit admission or death, according to study results published in JAMA Network Open.

During the ongoing coronavirus disease 2019 (COVID-19) pandemic, case reports have described patients without comorbidities developing severe COVID-19 after NSAID use in the early stages of the disease. Therefore, researchers sought to evaluate the potential association of NSAIDs with adverse outcomes in hospitalized patients with influenza or influenza pneumonia.

Risk ratio and risk difference for intensive care unit admission and death within 30 days of admission were calculated in patients (aged ≥40 years) hospitalized with influenza and whose diagnosis was confirmed by polymerase chain reaction or antigen testing. These risks were compared between patients who had a prescription filled of an NSAID within 60 days before admission and those patients who were taking NSAID therapy.

Of the 3980 patients hospitalized with influenza, 51.4% were men and the average age was 71 years. Of these 3980 patients, 520 had a prescription filled of an NSAID within 60 days before admission. In matched cohorts, 20.0% of the patients taking NSAIDs and 16.0% of those who did not take NSAIDs were admitted to the ICU. This yielded a risk ratio of 1.25 (95% CI, 0.96-1.63) and risk difference of 4.0% (95% CI, -0.6% to 8.7%). Furthermore, 7.1% of NSAID users and 6.9% of nonusers died, yielding a risk ratio of 1.03 (95% CI, 0.66-1.60) and risk difference of 0.2% (95% CI, -2.9% to 3.3%). Ultimately, these risks were not determined to be clinically significant.

“…NSAID use was not associated with a clinically significant increased risk of ICU admission or death in patients hospitalized with influenza,” the researchers wrote. “While studies on the association of NSAIDs with the disease course of COVID-19 are clearly needed, the currently available data, including the present study, do not seem to support strong recommendations against using NSAIDs in patients with viral pneumonia.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Lund LC, Reilev M, Hallas J, et al. Association of nonsteroidal anti-inflammatory drug use and adverse outcomes among patients hospitalized with influenza [published online July 1, 2020]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.13880