by Martin Schulz, Pia M. Schumacher, Juliana Schneider, André Said (Berlin), and Ulrich Laufs (Leipzig)
Explosive Drug Information in the Time of COVID-19 – the Case of Ibuprofen
In times of crises, findings are published quickly, spreading around the world within minutes. Here, validity and accuracy of (new) information is more important than ever, even though the general demand for rapid knowledge gain may mislead scientists to publish results without close scrutiny. Missing robust evidence could be responsible for fake or even ugly news unsettling the general population worldwide.
Regarding the current situation of COVID-19 outbreak, there are countless recommendations in public and social media to stop the intake of the non-steroidal anti-inflammatory drug (NSAID) ibuprofen because of an increased risk for and severity of COVID-19 infection, including eventual retractions.1 If, Fang et al.2 was and is still cited, and the recommendations most probably refer to the following statement in their correspondence, without providing a reference or data:
“ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes […]. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that […] treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.”2 To the best of our knowledge, both experimental and clinical data are missing to confirm these statements.
After further research concerning ibuprofen and ACE2, we found a paper published by Qiao et al. in 2015.3 In this work, the effect of ibuprofen on cardiac fibrosis was investigated in streptozotocin-induced diabetic rats. As a result, ACE2-levels were reduced in diabetic compared to control rats. After the administration of ibuprofen (or the thiazolidindione pioglitazone), they observed an upregulation of ACE2 in the diabetic rats. However, ACE2-levels were lower in comparison to healthy rats.
Thus, in addition to the absence of any clinical data there is currently no experimental evidence indicating to avoid ibuprofen in COVID-19 infected patients, of course, if treatment of fever, pain, or inflammation is necessary.
In accordance on 18 March, the European Medicines Agency (EMA) gave advice on the use of ibuprofen for COVID-19 and recommends patients and healthcare professionals to “consider all available treatment options including paracetamol and NSAIDs”.4
Further information on any effect of NSAIDs on COVID-19 may be obtained from the ongoing
review of the EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) on ibuprofen (and ketoprofen) on its effects on varicella and some bacterial infections. Until robust evidence is gained,
unconfirmed scientific statements should not fuel the suspicion about the probable impact of ibuprofen on the course of COVID-19, which has already led to shortages of paracetamol (acetaminophen)
More than ever, sharing (new) information referred to COVID-19 must be carried out responsibly.
1 https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms (accessed 18 March 2020); updated: WHO now doesn’t recommend avoiding ibuprofen for COVID-19 symptoms (accessed 19 March 2020).
2 Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020, March 11: doi: 10.1016/S2213-2600(20)30116-8.
3 Qiao W, Wang C, Chen B et al. Ibuprofen attenuates cardiac fibrosis in streptozotocin-induced diabetic rats. Cardiology 2015;131(2):97-106.
4 EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19. https://www.ema.europa.eu/en/news/ema-gives-advice-use-non-steroidal-anti-inflammatories-covid-19 (accessed 19 March 2020).