CHEST Guidelines-Safety-of-Ibuprofen-in-Patients-With-COVID-19

Safety-of-Ibuprofen-in-Patients-With-COVID-19_2020 (1)

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The document discusses the controversy over the safety of using ibuprofen in patients with COVID-19. Concerns were sparked by anecdotal reports from a French infectious disease specialist who observed worsening symptoms in four children with COVID-19 after ibuprofen use. This concern was echoed by the French Health Minister and initially supported by the World Health Organization (WHO), although the WHO later retracted its warning.<br /><br />The evidence against ibuprofen mostly rests on theoretical mechanisms, with some researchers suggesting that ibuprofen could increase ACE-2 activity, potentially exacerbating coronavirus infections. However, this hypothesis arises from mechanistic or theoretical studies, which are often not supported by clinical trials. Other studies cited include observational ones that link prehospital use of ibuprofen with negative outcomes in respiratory infections, but these findings are prone to biases like protopathic bias and confounding by disease severity.<br /><br />The document highlights the need for more robust research, preferably large population-based observational studies, to better assess ibuprofen's risks in COVID-19 patients. Such studies must adequately control for confounding factors, especially given over-the-counter ibuprofen use.<br /><br />Currently, the evidence is insufficient to establish a causal relationship between ibuprofen use and worsened COVID-19 outcomes. As a precaution, it is advised to use acetaminophen for fever reduction in COVID-19 patients, aligning with WHO recommendations. If acetaminophen alone is inadequate, coadministration with ibuprofen is not categorically discouraged, but its risks should be carefully weighed against potential benefits.

Keywords

ibuprofen

COVID-19

safety

anecdotal reports

ACE-2 activity

clinical trials

observational studies

confounding factors

acetaminophen

World Health Organization