Ibuprofen Covid-19 Warning May Be Premature

On Tuesday, the World Health Organization announced it is recommending that people with COVID-19 symptoms avoid taking the anti-inflammatory drug ibuprofen, but earlier today, theorganization reversed its recommendation citing a lack of evidence. The initial decision was made in response to a French government health alert issued on March 14 stating that serious adverse events associated with nonsteroidal anti-inflammatory drug (NSAID) use have been identified in patients with COVID-19.

French authorities recommended the use of acetaminophen instead. However, the European Medicines Agency, was quick to respond saying, "There is currently no scientific evidence establishing a link between ibuprofen and worsening of COVID‑19."

Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are strongly recommended by theAmerican College of Rheumatology(ACR) for patients with knee, hip, and/or hand osteoarthritis. It and other NSAIDs are often first-line therapies of choice for patients with inflammatory arthritis, such as rheumatoid arthritis.

But the concern of French authorities is that anti-inflammatory medications can hide the symptoms of an infection which can delay an accurate diagnosis. There is no evidence that ibuprofen or ketoprofen can lead to adverse outcomes in patients with COVID-19. In this country, because ibuprofen is associated with gastrointestinal and renal adverse events, acetaminophen or celecoxib is often the preferred treatment in these cases.

Rheumatologists recommend that patients continue to take anti-rheumatic, analgesic, anti-inflammatory, DMARD or biologic therapies as prescribed. Interrupting treatment could lead to flare-ups and remission relapse.

The ACR does not support the idea of stopping prednisone, DMARDs, or other drugs used to treat rheumatic disease, unless at the direction of a doctor. “All patients should talk to their rheumatologist or rheumatology professional prior to discontinuing any of their medications. While there are no data on the influence of these medications on COVID-19, providers should follow their current practice for interrupting therapy during episodes of infection,”the ACR stated on its website.