Researchers, Physicians Warn Against Anti-Inflammatory Use for COVID-19 Symptoms

Researchers and senior physicians have shown support for a French official’s claims that individuals showing symptoms of the novel coronavirus (COVID-19) should use paracetamol (acetaminophen) rather than ibuprofen, a drug they say may exacerbate the condition.¹

Oliver Véran, MD, France’s health minister, tweeted on March 14 that individuals with suspected COVID-19 should avoid anti-inflammatory drugs. “Taking anti-inflammatory drugs (ibuprofen, cortisone...) could be an aggravating factor for the infection. If you have a fever, take paracetamol,” he tweeted.

It is suspected that Véran’s comments were sparked, in part, by remarks attributed to an infectious disease doctor in southwest France. She reported citing 4 cases of young patients with COVID-19 and no underlying health problems who went on to develop serious symptoms after using non-steroidal anti-inflammatory drugs (NSAIDs) in the early stage of their symptoms.¹

Véran also pointed to research recently published in The Lancet, citing 2 studies that examined 32 non-survivors from a group of 52 intensive care unit patients with COVID-19. Comorbidities included cerebrovascular diseases (22%) and diabetes (22%). The study recommended that patients with cardiac diseases, hypertension, or diabetes, who are treated with angiotensin converting enzyme 2 (ACE2)-increasing drugs are at a higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or angiotensin receptor blockers.²

When asked about the study, World Health Organization spokesman Christian Lindmeier told reporters in Geneva that health agency’s experts were “looking into this to give further guidance. In the meantime, he said, “we recommend using rather paracetamol, and do not use ibuprofen as a self-medication. That’s important.” He added that if ibuprofen has been prescribed by a health care professional, their opinion may differ.³

Jean-Louis Montastruc, a professor medical and clinical pharmacology at the Central University Hospital in Toulouse, France, said that detrimental effects from NSAIDs are not surprising, given that since 2019, French health workers have been told not to treat fever or infections with ibuprofen based on the advice of the National Agency for the Safety of Medicines and Health Products.¹

Ian Jones, a professor of virology at the University of Reading, said that ibuprofen’s anti-inflammatory properties could “dampen down” the immune system, slowing the recovery process. He added that it was likely, based on similarities between SARS-CoV-2 and SARS I, that COVID-19 reduces a key enzyme that partly regulates the water and salt concentration in the blood and could contribute to the pneumonia seen in extreme cases.¹

Charlotte Warren-Gash, associate professor of epidemiology at the London School of Hygiene and Tropical Medicine, said that more research is needed for specific NSAIDs among individuals with different underlying health conditions. “In the meantime, for treating symptoms such as fever and sore throat, it seems sensible to stick to paracetamol as first choice,” she added.¹

“Patients taking cortisone or other steroids should not stop them except on advice from their doctor,” said Rupert Beale, an infectious diseases researcher at the Francis Crick Institute, who had a warning on cortisone.¹

The complex role that the immune system might play in COVID-19 has been underscored by reports that Swiss drug company Roche has secured approval from China for its anti-inflammation drug tocilizumab (Actemra, Roche) to treat patients developing severe complications from COVID-19.¹

Doctors in Italy, including Paolo Ascierto of the Pascale Hospital in Naples, claim that they have had success treating severely ill patients with the drug, which blocks the key inflammatory molecule interleukin-6.¹

There is speculation that the drug might prevent fatal “cytokine storms,” in which the immune system of seriously ill patients can cause organ failure.¹

Reference

• Day, Michael. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ website. https://doi.org/10.1136/bmj.m1086. Accessed March 18, 2020.
• Fang, L, Karakiulakis, G, Roth, M, et al. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet. Published March 11, 2020. https://doi.org/10.1016/S2213-2600(20)30116-8. Accessed March 18, 2020.
• WHO Now Officially Recommends to Avoid Taking Ibuprofen For COVID-19 Symptoms [news release]. Science Alert website. Published March 17, 2020. https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms. Accessed March 18, 2020.