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COVID-19 and Ibuprofen: Much ado about thin evidence
There is currently a lot of confusion about recommendations to better refrain from taking ibuprofen in case of infection with the new coronavirus SARS-CoV-2. After the World Health Organization only warned of ibuprofen, it has now withdrawn the warning. Even renowned German doctors see no evidence of an increased risk of COVID-19 sufferers among ibuprofen. The European Medicines Agency is now also taking a position on the subject.
"For me, the WHO warning is by no means conclusive, I think it is completely exaggerated," emphasizes Bernd Mühlbauer, director of the Institute for Clinical Pharmacology at the Bremen Mitte Clinic and board member of the Medicines Commission of the German Medical Association (AkdÄ) against the "Deutsche Ärzteblatt" . Nevertheless, there is nothing wrong with the recommendation to stick to paracetamol, since the drug is very safe compared to non-steroidal pain and inflammation inhibitors.
Much contradictory reports about ibuprofen
A Whats message recently circulated claiming that ibuprofen could worsen the course of COVID-19 disease. As the MedUni Vienna was mentioned in the message, the university quickly denied that it had anything to do with it.
The whole story was revived when French health minister Olivier Veran also warned of ibuprofen income from coronavirus infections in a Twitter message. Finally, even the WHO backed the warning, which made it increasingly serious - by health professionals as well as the press and lay people.
Now the connection is beginning to stumble again, since many specialist societies do not recognize any evidence behind the often mentioned connection. The WHO now admitted this and withdrew the warning. What is behind the whole vortex?
WHO withdraws warning of ibuprofen
WHO experts had consulted studies and experts and then concluded that there was no evidence that taking ibuprofen, in addition to the known side effects, had negative consequences for people with Covid 19. The organization subsequently withdrew its warning and said that based on the available information, it could not be advised against taking it.
Even the WHO can be wrong - how did this come about?
The confusion surrounding ibuprofen shows that even large institutions like the WHO can jump to conclusions. The warning was based on four Covid-19 cases from a French hospital where the condition worsened after taking anti-inflammatory drugs such as ibuprofen. The French pharmacologist Jean-Louis Montastruc then raised concerns.
Shortly afterwards, the British Medical Journal also quoted Professor Paul Little, who believed that nonsteroidal anti-inflammatory drugs (NSAIDs) would lead to increased complications in respiratory infections. In addition, the virologist Ian Jones suspected that ibuprofen promoted pneumonia by influencing the water and electrolyte balance.
The picture was rounded off by a study published by the specialist journal "The Lancet", which indicates that the new coronavirus enters the cells via ACE2 binding sites. These binding sites are increased by taking certain medications, including ibuprofen. It was now suspected that the increased number of ACE2 binding sites offers the virus better opportunities for attack.
EMA switches on
This chain of plausible arguments led the WHO to stand behind the warning. Now, however, the European Medicines Agency (EMA) also intervened and published its own opinion.
“There is currently no scientific evidence linking ibuprofen to the deterioration in COVID-19. The EMA is closely monitoring the situation and will review any new information that becomes available in connection with the pandemic on the subject, ”the EMA wrote in its statement.
New EMA recommendation
"When starting treatment for fever or pain in COVID-19, healthcare professionals and healthcare professionals should consider all available treatment options, including acetaminophen and NSAIDs," recommends the EMA. Each drug has its own benefits and risks, which are reflected in the product information. Paracetamol is already mentioned in the EU's national treatment guidelines as the first treatment option for fever or pain.
"In accordance with EU national treatment guidelines, sufferers and health professionals can continue to use NSAIDs such as ibuprofen in accordance with the approved product information," EMA said. According to the recommendations, this drug should only be used in the lowest effective dose for as short a period as possible. There is currently no reason to stop taking ibuprofen due to the doubts mentioned. This is particularly true for the chronically ill who are dependent on NSAID medication. (vb)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Graduate editor (FH) Volker Blasek
- European Medicines Agency: EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19 (published: 18.03.2020), ema.europa.eu
- Ärzteblatt: No evidence of increased risk for COVID-19 patients under ibuprofen (published: March 18, 2020), aerzteblatt.de