Non-steroidal anti-inflammatory drugs, pharmacology, and COVID-19 infection.
Angiotensin-Converting Enzyme 2
Animals
Anti-Inflammatory Agents, Non-Steroidal
/ administration & dosage
Bacterial Infections
/ epidemiology
COVID-19
Coronavirus Infections
/ drug therapy
France
Humans
Ibuprofen
/ administration & dosage
Pandemics
Peptidyl-Dipeptidase A
/ drug effects
Pneumonia, Viral
/ drug therapy
Anti-inflammatory agents, non-steroidal
COVID-19
Infections
Pharmacoepidemiology
Pharmacovigilance
Respiratory tract infections
Superinfection
Journal
Therapie
ISSN: 1958-5578
Titre abrégé: Therapie
Pays: France
ID NLM: 0420544
Informations de publication
Date de publication:
Historique:
received:
26
04
2020
accepted:
05
05
2020
pubmed:
19
5
2020
medline:
2
9
2020
entrez:
19
5
2020
Statut:
ppublish
Résumé
Non-steroidal anti-inflammatory drugs (NSAIDs) have an optional prescription status that has resulted in frequent use, in particular for the symptomatic treatment of fever and non-rheumatic pain. In 2019, a multi-source analysis of complementary pharmacological data showed that using NSAIDs in these indications (potentially indicative of an underlying infection) increases the risk of a severe bacterial complication, in particular in the case of lung infections. First, the clinical observations of the French Pharmacovigilance Network showed that severe bacterial infections can occur even after a short NSAID treatment, and even if the NSAID is associated with an antibiotic. Second, pharmacoepidemiological studies, some of which minimized the protopathic bias, all converged and confirmed the risk. Third, experimental in vitro and in vivo animal studies suggest several biological mechanisms, which strengthens a causal link beyond the well-known risk of delaying the care of the infection (immunomodulatory effects, effects on S. pyogenes infections, and reduced antibiotics efficacy). Therefore, in case of infection, symptomatic treatment with NSAIDs for non-severe symptoms (fever, pain, or myalgia) is not to be recommended, given a range of clinical and scientific arguments supporting an increased risk of severe bacterial complication. Besides, the existence of a safer drug alternative, with paracetamol at recommended doses, makes this recommendation of precaution and common sense even more legitimate. In 2020, such recommendation is more topical than ever with the emergence of COVID-19, especially since it results in fever, headaches, muscular pain, and cough, and is further complicated with pneumopathy, and given experimental data suggesting a link between ibuprofen and the level of expression of angiotensin-converting enzyme 2.
Identifiants
pubmed: 32418728
pii: S0040-5957(20)30092-5
doi: 10.1016/j.therap.2020.05.003
pmc: PMC7204680
pii:
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Peptidyl-Dipeptidase A
EC 3.4.15.1
ACE2 protein, human
EC 3.4.17.23
Angiotensin-Converting Enzyme 2
EC 3.4.17.23
Ibuprofen
WK2XYI10QM
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
355-362Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.
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