Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts

AY Wong; B MacKenna; CE Morton; A Schultze; AJ Walker; K Bhaskaran; JP Brown; CT Rentsch; E Williamson; H Drysdale; R Croker; S Bacon; W Hulme; OpenSAFELY Collaborative

doi:10.1136/annrheumdis-2020-219517

Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts

AY Wong^*, B MacKenna, CE Morton, A Schultze, AJ Walker, K Bhaskaran, JP Brown, CT Rentsch, E Williamson, H Drysdale, R Croker, S Bacon, W Hulme, OpenSAFELY Collaborative

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

73 Citations (Scopus)

65 Downloads (Pure)

Abstract

Objectives To assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform.

Methods 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.

Results 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.

Conclusions 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.

https://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/annrheumdis-2020-219517

Original language	English
Pages (from-to)	943-951
Number of pages	9
Journal	Annals of the Rheumatic Diseases
Volume	80
Issue number	7
Early online date	21 Jan 2021
DOIs	https://doi.org/10.1136/annrheumdis-2020-219517
Publication status	Published - Jul 2021

Bibliographical note

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.

Research Groups and Themes

Covid19

Access to Document

10.1136/annrheumdis-2020-219517

Full-text PDF (final published version)
This is the final published version of the article (version of record). It first appeared online via BMJ Publishing Group at http://dx.doi.org/10.1136/annrheumdis-2020-219517 . Please refer to any applicable terms of use of the publisher.
Final published version, 803 KBLicence: CC BY

Handle.net

Persistent link

Cite this

Wong, AY., MacKenna, B., Morton, CE., Schultze, A., Walker, AJ., Bhaskaran, K., Brown, JP., Rentsch, CT., Williamson, E., Drysdale, H., Croker, R., Bacon, S., Hulme, W., & Collaborative, OAFELY. (2021). Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts. Annals of the Rheumatic Diseases, 80(7), 943-951. https://doi.org/10.1136/annrheumdis-2020-219517

@article{006d03c8a3df4430bcbe389811868d73,

title = "Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts",

abstract = "Objectives To assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform. Methods 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. Results 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. Conclusions 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. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. http://dx.doi.org/10.1136/annrheumdis-2020-219517",

author = "AY Wong and B MacKenna and CE Morton and A Schultze and AJ Walker and K Bhaskaran and JP Brown and CT Rentsch and E Williamson and H Drysdale and R Croker and S Bacon and W Hulme and OpenSAFELY Collaborative",

note = "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{\textquoteright}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{\textquoteright}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: {\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.",

year = "2021",

month = jul,

doi = "10.1136/annrheumdis-2020-219517",

language = "English",

volume = "80",

pages = "943--951",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "Elsevier B.V.",

number = "7",

}

Wong, AY, MacKenna, B, Morton, CE, Schultze, A, Walker, AJ, Bhaskaran, K, Brown, JP, Rentsch, CT, Williamson, E, Drysdale, H, Croker, R, Bacon, S, Hulme, W & Collaborative, OAFELY 2021, 'Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts', Annals of the Rheumatic Diseases, vol. 80, no. 7, pp. 943-951. https://doi.org/10.1136/annrheumdis-2020-219517

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, AY

AU - MacKenna, B

AU - Morton, CE

AU - Schultze, A

AU - Walker, AJ

AU - Bhaskaran, K

AU - Brown, JP

AU - Rentsch, CT

AU - Williamson, E

AU - Drysdale, H

AU - Croker, R

AU - Bacon, S

AU - Hulme, W

AU - Collaborative, OpenSAFELY

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

Y1 - 2021/7

N2 - Objectives To assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform. Methods 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. Results 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. Conclusions 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. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. http://dx.doi.org/10.1136/annrheumdis-2020-219517

AB - Objectives To assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform. Methods 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. Results 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. Conclusions 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. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. http://dx.doi.org/10.1136/annrheumdis-2020-219517

UR - http://europepmc.org/abstract/med/33478953

U2 - 10.1136/annrheumdis-2020-219517

DO - 10.1136/annrheumdis-2020-219517

M3 - Article (Academic Journal)

C2 - 33478953

SN - 0003-4967

VL - 80

SP - 943

EP - 951

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 7

ER -

Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts

Abstract

Bibliographical note

Research Groups and Themes

Access to Document

Handle.net

Other files and links

Fingerprint

Cite this