An Israeli research team has found that ibuprofen does not aggravate symptoms caused by the coronavirus. This comes after the reigning controversy that rose after the French government claimed in March that ibuprofen could aggravate infections.
Following the announcement made in France, researchers from the Ben-Gurion University of the Negev in Beersheba did a follow up study that aimed to evaluate whether the use of ibuprofen in coronavirus patients was associated with more severe cases compared with patients who used paracetamol, also known as acetaminophen, or no antipyretics, a substance that reduces fever.
Ibuprofen, an antipyretic, is also an anti-inflammatory drug, and is used as a pain killer. While paracetamol is used in treatment for similar symptoms, both drugs are metabolized in the body differently. Ibuprofen is primarily metabolized in the kidneys and paracetamol is processed in the liver.
, called Ibuprofen use and clinical outcomes in COVID-19 patients, was published in the Clinical Microbiology and Infection journal. It monitored the use of ibuprofen in 403 patients from Shamir Medical Center in Be'er Ya'acv, Israel, from a week before their diagnosis throughout the infection period. The most commonly used antipyretic was paracetamol (32% of the population), with 22% reporting using ibuprofen and 3.7% using dipyrone.
Results found that there was a similar outcome between patients who took ibuprofen versus patients who took paracetamol. In fact, it was found that the rate of patients who needed respiratory support was higher in the paracetamol group with borderline significance. However, it was theorized that this could owe to the fact that the elderly patients, who are more likely to need respiratory support as is, are also more likely to be treated with paracetamol due to concerns of renal injuries.
The only other major significance shown between the usage of ibuprofen and paracetamol users is that 79% of ibuprofen users presented with fevers while only 35% of non-ibuprofen takers presented with fever.
Otherwise researchers stated that they "did not observe an increased risk for mortality or the need for respiratory support in patients treated with ibuprofen."
In the ibuprofen group, 3 (3.4%) patients died, whereas in the non-ibuprofen group 9 (2.8%) patients died. Nine (10%) patients from the ibuprofen group needed respiratory support, compared with 35 (11%) from the non-ibuprofen group. No difference in mortality rates was observed. One (2%) of the exclusive ibuprofen users needed any respiratory support during their disease course, compared with 11 (12.9%) of the exclusive paracetamol users.
It should be noted that patients with fever who used paracetamol or ibuprofen exclusively had similar age and gender. The median age was 45 years, 220 of patients studied (55%) were male, and 101 (25%) had chronic diseases.
These group of patients used in the study tested positive for the virus at Shamir Medical Center, Israel, between 15 March and 15 April 2020. Of the entire cohort, 89% presented with mild symptoms with no need for respiratory support, the remainder either needing respiratory support or admitting into the hospital's intensive care unit, and a total of 12 (3% died).
The day before the study started, the French government announced that non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen, could result in "grave adverse effects" in those suffering from COVID-19. Moreover, on March 19, the United States Food and Drug Administration (FDA) produced a statement announcing their advisement against the use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19.
A lot of controversy came about among the international medical field following France's statement. One expert from the University of St Andres Infection and Global Health Division researcher Muge Cevik, wrote over Twitter that "There's no scientific evidence I am aware of that ibuprofen [causes worse] outcomes in #COVID19."
However, other experts argue that drugs like ibuprofen should be avoided, even if the connection isn't fully understood. One such expert – Rupert Beale, group leader in Cell Biology of Infection at the UK's Francis Crick Institute – said that "There is a good reason to avoid ibuprofen as it may exacerbate acute kidney injury brought on by any severe illness, including severe COVID-19 disease," CNN reported.
This is also supported by Prof. Charlotte Warren-Gash, of the London School of Hygiene and Tropical Medicine.
"Most deaths from COVID-19 have been among older people and those with underlying health conditions such as cardiovascular disease. We already know that NSAIDs should be prescribed with caution for people who have underlying health conditions," she told CNN.
In the UK, ibuprofen prescriptions to those with underlying conditions are recommended in the lowest possible dosage and for the shortest possible duration. The reason for this is because of the chance of adverse side effects, such as those in the kidneys and cardiovascular system.
France is even more severe, as their strict regulations on painkillers have caused ibuprofen to be moved behind the counter, rather than being available over the counter.Aaron Reich contributed to this report.