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      Non-steroidal anti-inflammatory drugs, pharmacology, and COVID-19 infection

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          Summary

          Non-steroidal anti-inflammatory drugs (NSAIDs) have an optional prescription status that has resulted in frequent use, in particular for the symptomatic treatment of fever and non-rheumatic pain. In 2019, a multi-source analysis of complementary pharmacological data showed that using NSAIDs in these indications (potentially indicative of an underlying infection) increases the risk of a severe bacterial complication, in particular in the case of lung infections. First, the clinical observations of the French Pharmacovigilance Network showed that severe bacterial infections can occur even after a short NSAID treatment, and even if the NSAID is associated with an antibiotic. Second, pharmacoepidemiological studies, some of which minimized the protopathic bias, all converged and confirmed the risk. Third, experimental in vitro and in vivo animal studies suggest several biological mechanisms, which strengthens a causal link beyond the well-known risk of delaying the care of the infection (immunomodulatory effects, effects on Streptococcus pyogenes infections, and reduced antibiotics efficacy). Therefore, in case of infection, symptomatic treatment with NSAIDs for non-severe symptoms (fever, pain, or myalgia) is not to be recommended, given a range of clinical and scientific arguments supporting an increased risk of severe bacterial complication. Besides, the existence of a safer drug alternative, with paracetamol at recommended doses, makes this recommendation of precaution and common sense even more legitimate. In 2020, such recommendation is more topical than ever with the emergence of COVID-19, especially since it results in fever, headaches, muscular pain, and cough, and is further complicated with pneumopathy, and given experimental data suggesting a link between ibuprofen and the level of expression of angiotensin-converting enzyme 2.

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          Author and article information

          Contributors
          Journal
          Therapie
          Therapie
          Therapie
          Published by Elsevier Masson SAS on behalf of Société française de pharmacologie et de thérapeutique.
          0040-5957
          1958-5578
          7 May 2020
          7 May 2020
          Affiliations
          [a ]Aix-Marseille université, Inserm, UMR 1106, Assistance publique – Hôpitaux de Marseille, service de pharmacologie clinique, centre régional de pharmacovigilance, 13005 Marseille, France
          [b ]Centre hospitalier régional universitaire de Tours, service de pharmacosurveillance, centre régional de pharmacovigilance, 37000 Tours, France
          Author notes
          [* ]Corresponding author. Service de pharmacologie clinique, centre de pharmacovigilance, AP-HM, 264 rue Saint Pierre, 13005 Marseille, France joelle.micallef@ 123456ap-hm.fr
          Article
          S0040-5957(20)30092-5
          10.1016/j.therap.2020.05.003
          7204680
          32418728
          a7c2bb3c-7a48-4f7f-8f2a-dfd064f864c2
          © 2020 Published by Elsevier Masson SAS on behalf of Société française de pharmacologie et de thérapeutique.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

          History
          : 26 April 2020
          : 5 May 2020
          Categories
          Article

          ace2, angiotensin-converting enzyme 2,ansm, national agency for the safety of medicines and health products,cox-2, inducible cyclooxygenase,crpv, regional pharmacovigilance centers,nsaids, non-steroidal anti-inflammatory drugs,tnf-α, tumor necrosis factor-α,anti-inflammatory agents,non-steroidal,infections,respiratory tract infections,superinfection,covid-19,pharmacovigilance,pharmacoepidemiology

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