TY - JOUR
T1 - Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19
T2 - An OpenSAFELY cohort analysis based on two cohorts
AU - Wong, Angel Y.S.
AU - MacKenna, Brian
AU - Morton, Caroline E.
AU - Schultze, Anna
AU - Walker, Alex J.
AU - Bhaskaran, Krishnan
AU - Brown, Jeremy P.
AU - Rentsch, Christopher T.
AU - Williamson, Elizabeth
AU - Drysdale, Henry
AU - Croker, Richard
AU - Bacon, Seb
AU - Hulme, William
AU - Bates, Chris
AU - Curtis, Helen J.
AU - Mehrkar, Amir
AU - Evans, David
AU - Inglesby, Peter
AU - Cockburn, Jonathan
AU - McDonald, Helen I.
AU - Tomlinson, Laurie
AU - Mathur, Rohini
AU - Wing, Kevin
AU - Forbes, Harriet
AU - Eggo, Rosalind M.
AU - Parry, John
AU - Hester, Frank
AU - Harper, Sam
AU - Evans, Stephen J.W.
AU - Smeeth, Liam
AU - Douglas, Ian J.
AU - Goldacre, Ben
N1 - Funding Information:
Competing interests BG has received research funding from Health Data
Funding Information:
Funding TPP provided technical expertise and infrastructure within their data centre pro bono in the context of a national emergency. BG’s work on better use of data in healthcare more broadly is currently funded in part by: National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation, NHS England and the Health Foundation; all DataLab staff are supported by BG’s grants on this work. LS reports grants from Wellcome, MRC, NIHR, UKRI, British Council, GlaxoSmithKline, British Heart Foundation, and Diabetes UK outside this work. AYSW holds a fellowship from British Heart Foundation. JPB is funded by a studentship from GlaxoSmithKline. AS is employed by London School of Hygiene and Tropical Medicine on a fellowship sponsored by GlaxoSmithKline. KB holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society (107731/Z/15/Z)). HIM is funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, a partnership between Public Health England and London School of Hygiene and Tropical Medicine. RM holds a Sir Henry Wellcome fellowship (201375/Z/16/Z)). EW holds grants from MRC. RG holds grants from NIHR and MRC. ID holds grants from NIHR and GlaxoSmithKline. HF holds a UKRI fellowship.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - To assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform. We conducted two cohort studies from 1 March to 14 June 2020. Working on behalf of National Health Service England, we used routine clinical data in England linked to death data. In study 1, we identified people with an NSAID prescription in the last 3 years from the general population. In study 2, we identified people with rheumatoid arthritis/osteoarthritis. We defined exposure as current NSAID prescription within the 4 months before 1 March 2020. We used Cox regression to estimate HRs for COVID-19 related death in people currently prescribed NSAIDs, compared with those not currently prescribed NSAIDs, accounting for age, sex, comorbidities, other medications and geographical region. In study 1, we included 536 423 current NSAID users and 1 927 284 non-users in the general population. We observed no evidence of difference in risk of COVID-19 related death associated with current use (HR 0.96, 95% CI 0.80 to 1.14) in the multivariable-adjusted model. In study 2, we included 1 708 781 people with rheumatoid arthritis/osteoarthritis, of whom 175 495 (10%) were current NSAID users. In the multivariable-adjusted model, we observed a lower risk of COVID-19 related death (HR 0.78, 95% CI 0.64 to 0.94) associated with current use of NSAID versus non-use. We found no evidence of a harmful effect of routinely prescribed NSAIDs on COVID-19 related deaths. Risks of COVID-19 do not need to influence decisions about the routine therapeutic use of NSAIDs.
AB - To assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform. We conducted two cohort studies from 1 March to 14 June 2020. Working on behalf of National Health Service England, we used routine clinical data in England linked to death data. In study 1, we identified people with an NSAID prescription in the last 3 years from the general population. In study 2, we identified people with rheumatoid arthritis/osteoarthritis. We defined exposure as current NSAID prescription within the 4 months before 1 March 2020. We used Cox regression to estimate HRs for COVID-19 related death in people currently prescribed NSAIDs, compared with those not currently prescribed NSAIDs, accounting for age, sex, comorbidities, other medications and geographical region. In study 1, we included 536 423 current NSAID users and 1 927 284 non-users in the general population. We observed no evidence of difference in risk of COVID-19 related death associated with current use (HR 0.96, 95% CI 0.80 to 1.14) in the multivariable-adjusted model. In study 2, we included 1 708 781 people with rheumatoid arthritis/osteoarthritis, of whom 175 495 (10%) were current NSAID users. In the multivariable-adjusted model, we observed a lower risk of COVID-19 related death (HR 0.78, 95% CI 0.64 to 0.94) associated with current use of NSAID versus non-use. We found no evidence of a harmful effect of routinely prescribed NSAIDs on COVID-19 related deaths. Risks of COVID-19 do not need to influence decisions about the routine therapeutic use of NSAIDs.
KW - arthritis
KW - COVID-19
KW - epidemiology
KW - osteoarthritis
KW - rheumatoid
UR - http://www.scopus.com/inward/record.url?scp=85099940654&partnerID=8YFLogxK
U2 - 10.1136/annrheumdis-2020-219517
DO - 10.1136/annrheumdis-2020-219517
M3 - Article
C2 - 33478953
AN - SCOPUS:85099940654
SN - 0003-4967
VL - 80
SP - 943
EP - 951
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 7
ER -