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Ibuprofen and COVID-19 Severity

Ibuprofen has been in the news recently due to speculation it might promote cell binding of the virus in COVID-19 patients. This large-scale analysis of EHR data begins to examine that question.

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Investigators examined whether patients who were prescribed ibuprofen before they were infected with COVID-19 showed a difference in disease severity. Patients who were prescribed ibuprofen before infection had less severe outcomes. This appeared to be the case regardless of sex or age group.

We include patients in the “prescribed ibuprofen” group if they had a prescription for ibuprofen within 30 days before they were admitted for COVID-19 or within 30 days of testing positive for COVID-19 and they had at least two refills on record. Prescriptions that indicated “take as needed” and patient-reported medications were excluded. In addition, prescriptions with a start date after March 1, 2020 were excluded because prescription patterns might have been impacted by media coverage encouraging patients to avoid ibuprofen with COVID-19.

Given this definition, a limitation of this study is that some patients who were prescribed ibuprofen may have taken their medications intermittently, some may have never taken their prescriptions, and some may have stopped taking their prescribed ibuprofen following the public concern for ibuprofen use during COVID-19 infection. In addition, patients not included in the prescribed group might have been taking ibuprofen over-the-counter.

Summary data were analyzed for 33,567 COVID-19 positive patients with data on ibuprofen prescription prior to infection. Patients recently diagnosed or admitted were excluded. Data were summarized from 23 health systems, representing 146 hospitals, spanning 11 states and covering 89 million patients.

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Preliminary observations suggest a possible association between ibuprofen prescription and lower severity of symptoms experienced among patients with COVID-19, although there may be other factors associated with both ibuprofen prescription and lower severity of COVID-19 disease that are not addressed in this analysis.

Patients with chronic prescriptions may be more likely to have regular access to care, which may account for the observed effect. Also, there may be an association between prescription for ibuprofen and certain chronic diseases. Future research should control for comorbidities to address this potential source of bias. Additionally, future research should investigate whether similar patterns exist for other members of the class of medications called non-steroidal anti-inflammatory drugs (NSAIDs), of which ibuprofen is an example. 

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