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

Safety-of-Ibuprofen-in-Patients-With-COVID-19_2020

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The document discusses the controversial use of ibuprofen in patients with COVID-19, focusing on its safety and potential risks. Initially, concerns arose from anecdotal reports by a French infectious disease specialist about children with COVID-19 experiencing worsened symptoms after taking ibuprofen, leading to international concern and recommendations from the French Health Minister and WHO to avoid the drug. Although the WHO later retracted its warning, the debate has persisted.<br /><br />The article examines current evidence, emphasizing that while mechanistic studies suggest a theoretical risk due to ibuprofen's potential effect on the ACE-2 enzyme—believed to facilitate coronavirus entry into cells—these findings are not substantiated by clinical trials. Epidemiologic studies and literature often exhibit biases, such as protopathic bias, where ibuprofen use seems harmful due to its use for treating symptoms of more severe disease, not the drug itself.<br /><br />Research from previous respiratory infection studies cited also points to a negative outlook on ibuprofen due to its association with poor outcomes in similar conditions like pneumonia. However, these studies also have confounding factors that need consideration. Concerns about severity bias—patients with more severe symptoms are likelier candidates for ibuprofen instead of acetaminophen—suggest that worse outcomes might be due to disease severity rather than the drug.<br /><br />The article concludes by recommending acetaminophen as the first-line treatment for fever in COVID-19 patients, in line with WHO guidance. If necessary, ibuprofen might be co-administered, but its risks and benefits should be carefully evaluated. The current evidence is deemed insufficient to confirm any harmful causal link between ibuprofen and COVID-19 outcomes. A large observational study could provide more insights, but possible data confounding presents challenges.

Keywords

ibuprofen

COVID-19

safety

risks

ACE-2 enzyme

clinical trials

epidemiologic studies

severity bias

acetaminophen

WHO guidance