No Evidence of NSAID Risk in COVID Severity or Death
The theoretical risk that ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) could increase risk of infection and severity of SARS-CoV-2 (COVID-19) was not supported by the data in a recent study published online in Drug Safety.
Since the early days of the COVID-19 pandemic, French health officials and other physicians questioned whether NSAIDs might be dangerous in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, although most physicians in the United States advised consumers and patients to check with their doctors before abruptly stopping any NSAID they might have been taking.
The concern among some European and United Kingdom health officials last year was that NSAIDs could increase the risk of infection or the severity of SARS-CoV-2. However, an analysis conducted at the University of Bordeaux and published in late 2021 has demonstrated no data to support this theoretical concern.
The research team retrieved original studies that provided information on exposure to NSAIDs and coronavirus disease 2019 (COVID-19) outcomes. They included the studies in a descriptive analysis and a meta-analysis with Cochrane Revue Manager (REVMAN 5.4), using inverse variance odds ratio (OR) with random- or fixed-effects models.
The results are based on 92,853 articles they found that mentioned COVID-19.
Of those 92,853 articles, 266 mentioned NSAIDs and 61 mentioned ibuprofen; 19 articles had analyzable data; 3 articles described NSAID exposure and the risk of SARS-CoV-2 positivity; 5 articles described the risk of hospital admission in positive patients; 10 articles described death; 6 articles described severe composite outcomes; and 5 articles studied exposure to ibuprofen and death.
Using random-effects models, there was no excess risk of SARS-CoV-2 positivity (OR, 0.86; 95% confidence interval [CI], 0.71-1.05).
In SARS-CoV-2-positive patients, exposure to NSAIDs was not associated with excess risk of hospital admission (OR, 0.90; 95% CI, 0.80-1.17), death (OR, 0.88; 95% CI, 0.80-0.98), or severe outcomes (OR, 1.14; 95% CI 0.90-1.44).
With ibuprofen, there was no increased risk of death (OR, 0.94; 95% CI, 0.78-1.13). Using a fixed-effect model did not modify the results, nor did the sensitivity analyses. (See Moore N, Bosco-Levy P, Thurin N, et al. NSAIDs and COVID-19: a systematic review and meta-analysis. Drug Saf. 2021;44:929-938. doi:10.1007/s40264-021-01089-5.)
Botox Could Reduce High-Frequency Episodic Migraine
Research from an exploratory study presented at the virtual meeting of the XXV World Congress of Neurology suggests that onabotulinumtoxinA (BoNT-A, Botox) may reduce days of high-frequency episodic migraine (HFEM), as reported by Medscape Medical News in October.
"High-frequency episodic migraine is a risky condition for chronic migraine," co-investigator Daniele Martinelli, MD, University of Pavia, Pavia, Italy, told meeting attendees, Medscape reported.
HFEM, Martinelli noted, is likely a transition state from low/moderate-frequency episodic migraine to chronic migraine. He said that a drug that prevents general sensitization would hold promise for treating HFEM as well.
"Focusing on preventive treatment...becomes extremely important both for lowering the migraine frequency and for preventing transition to chronic migraine, [inasmuch as] peripheral and central sensitization are deeply implicated in chronic migraine," Martinelli said, as reported in the Medscape article.
Martinelli reported that "administration of BoNT-A in accordance with the Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol effectively reduced the number of monthly migraine days for patients with HFEM, meeting the primary outcome. It also diminished intake of acute medications. The PREEMPT protocol is being studied in a phase 3 trial."
In this protocol, BoNT-A is injected into muscles of the head and neck. Injections are given at both fixed sites and in "follow-the-pain" sites, depending on individual patients' symptoms. (See Keller DM. Botox cuts frequency of episodic migraine, need for acute meds. Medscape Medical News, October 21, 2021. https://www.medscape.com/viewarticle/961349?uac=178501SR&faf=1&sso=true&impID=37.)