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Warning Against the Use of Anti-Inflammatory Medicines to Cure COVID-19: Building Castles in the Air

April 2020
Advances in Therapy 37(5)

Project: Pain Medicine

Authors:

Paolo Procacci Foundation

COVID-19 is developing rapidly and invading the whole world in a real pandemic. There is much discussion (appropriate or less appropriate,) on this hot topic. Recent declarations have focused attention on the risk of interactions between NSAIDs and COVID-19. There are also theories on the potential interactions between the use of ACE inhibitors, the use of ibuprofen and the increased risk of infection. At the moment, there are no data in the literature showing that this would be the case. Pain patients may be reassured by their physicians on the safety of using ACE inhibitors and NSAIDs (especially ibuprofen), because there is nothing to show the potential for an increased risk of viral infection, and especially of COVID-19.

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EDITORIAL

Warning Against the Use of Anti-Inﬂammatory

Medicines to Cure COVID-19: Building Castles

in the Air

Giustino Varrassi

Received: March 23, 2020

The Author(s) 2020

Keywords: Anti-inﬂammatory medicines;

COVID-19; NSAIDs

Key Summary Points

COVID-19 is developing rapidly and

invading the whole world in a real

pandemic.

There is much discussion, appropriate or

less appropriate, of this hot topic.

Recent declarations have focused

attention on the risk of interactions

between NSAIDs and COVID-19.

There are also theories on the potential

interactions between the use of ACE

inhibitors, the use of ibuprofen and the

increased risk of infection.

At the moment, there are no data in the

literature showing that this would be the

case.

Pain patients may be reassured by their

physicians on the safety of using ACE

inhibitors and NSAIDs (especially

ibuprofen), because there is nothing to

show the potential for an increased risk

of viral infection, and especially of

COVID-19.

A recent article in Le Figaro has focused atten-

tion on the use of anti-inﬂammatory medicines

because they could be responsible for an

increased incidence of infections due to

COVID-19 [1]. This article reports and empha-

sizes the opinion of politicians expressed via

social media suggesting the use of one medicine

instead of others, but not referencing opinions

based on scientiﬁc data.

A recent article focused its attention on the

supposed relationship between chronic

pathologies (hypertension and diabetes melli-

tus) and COVID-19 infection and their phar-

macological treatment [2]. The initial

assumption is based on two recent papers

reporting the clinical experience in China,

during the dramatic epidemic now becoming a

pandemic [3,4]. Both articles suggest that

patients affected by COVID-19 frequently had

concomitant chronic pathologies, especially

hypertension and diabetes mellitus, pathologies

that might be treated with angiotensin-con-

verting-enzyme (ACE) inhibitors. Fang et al. [2]

Enhanced Digital Features To view enhanced digital

features for this article go to https://doi.org/10.6084/

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G. Varrassi (&)

Paolo Procacci Foundation, via Tacito 7,

00193 Rome, Italy

e-mail: giuvarr@gmail.com

Adv Ther

https://doi.org/10.1007/s12325-020-01321-1

based their intriguing theory, of an increased

risk of COVID-19 infection on patients treated

with ACE inhibitors, on the relationship

between the ACE system, which can be inﬂu-

enced by anti-inﬂammatory medicines, and the

lung epithelial cells. Following this theory, their

conclusion was the most obvious: ‘‘…patients

…treated with ACE2-increasing drugs are at

higher risk for severe COVID-19 infection…’’ .

None of the quoted articles reporting the clini-

cal experience in China has assessed the previ-

ous pharmacological therapy of the patients

infected by COVID-19 [3,4].

In the last part of this recent article, the

authors suggest that, based on a search on

PubMed made on February 28, 2020, there are

no reports on the potential inﬂuence of calcium

channel blockers on ACE2 activity [2]. There-

fore, these drugs could be used as an ‘‘alterna-

tive treatment in these patients’’. Actually,

nobody knows what the pharmacological ther-

apy of the Chinese patients was. Maybe some of

them were already using calcium antagonists.

Hence, it seems that Fang et al.’s [2] theory is

not related to what is reported in the two Chi-

nese papers.

Recently (March 9, 2020), I carried out a very

thorough literature search for all the published

material on COVID-19. None of the articles

found on PubMed reports data connecting the

use of ACE-inhibitors or NSAIDs to an increased

incidence or risk of COVID-19 infection. I am

not excluding that it might be shown in the

future, when the literature will have more clear

and valid scientiﬁc information, but at the

moment it seems very premature. I think that,

especially in a dramatic moment like the one we

are living in, it would be more prudent to pre-

vent the temptation to build castles in the air.

ACKNOWLEDGEMENTS

Funding. This article has been possible

thanks to the unconditional support of the

Paolo Procacci Foundation. No Rapid Service

Fee was received by the journal for the publi-

cation of this article.

Authorship. The named author meets the

International Committee of Medical Journal

Editors (ICMJE) criteria for authorship for this

article, takes responsibility for the integrity of

the work as a whole, and has given approval for

this version to be published.

Disclosures. Giustino Varrassi is a section

editor of this journal.

Compliance with Ethics Guidelines. The

article is based on previously conducted studies

and publications, and does not contain any

studies with human participants or animals

performed by the author.

Data Availability. Data sharing is not

applicable to this article as no datasets were

generated or analyzed during the current study.

Open Access. This article is licensed under a

Creative Commons Attribution-NonCommer-

cial 4.0 International License, which permits

any non-commercial use, sharing, adaptation,

distribution and reproduction in any medium

or format, as long as you give appropriate credit

to the original author(s) and the source, provide

a link to the Creative Commons licence, and

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REFERENCES

1https://www.leﬁgaro.fr/sciences/coronavirus-alerte-sur-

l-ibuprofene-et-autres-anti-inﬂammatoires-20200314.

Accessed 15 Mar 2020.

2 Fang L, Karakiulakis G, Roth M. Are patients with

hypertension and diabetes mellitus at increased risk

Adv Ther

for COVID-19 infection? Lancet Respir Med. 2020.

https://doi.org/10.1016/PII (published on line March

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observational study. Lancet Respir Med. 2020. https://

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