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

Authors:
  • Paolo Procacci Foundation

Abstract

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.
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
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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
indicate if changes were made. The images or
other third party material in this article are
included in the article’s Creative Commons
licence, unless indicated otherwise in a credit
line to the material. If material is not included
in the article’s Creative Commons licence and
your intended use is not permitted by statutory
regulation or exceeds the permitted use, you
will need to obtain permission directly from the
copyright holder. To view a copy of this licence,
visit http://creativecommons.org/licenses/by-
nc/4.0/.
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
11).
3 Yang X, Yu Y, Xu J, et al. Clinical course and outcomes
of critically ill patients with SARS-CoV-2 pneumonia
in Wuhan, China: a single-centered, retrospective,
observational study. Lancet Respir Med. 2020. https://
doi.org/10.1016/S2213-2600(20)30079-5 (published
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4 Guan W, Ni Z, Hu Y, et al. Clinical characteristics of
coronavirus disease 2019 in China. N Engl J Med.
2020. https://doi.org/10.1056/NEJMoa2002032 (pub-
lished online Feb 28).
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