There is a growing trend of moving back towards NSAIDs in the countries worst affected by the pandemic. For patients with mild to moderate symptoms, the most effective form of healthcare support for COVID-19 remains to be supportive therapy, one of which is the analgesic ibuprofen. Non-steroidal anti-inflammatory drugs or NSAIDs have been a part of general healthcare since long, thanks to their wide range of uses.
One of the first pieces of advice on the use of NSAIDs such as ibuprofen on the cases of COVID-19 came from the European Medicines Agency back in March 2020 and it has been a constant part of press articles and media publications since then. Along with all the other speculatively effective drugs which are being researched both in labs and clinically, this has also been a part of a lot of hypothesizing going on, on both the positive and the negative effects of them.
The idea behind using an anti-inflammatory drug originates from the very nature of how the novel coronavirus affects the body. One of the initial commentary publications of the WHO regarding multisystem inflammatory effects in some cases of the infection indicated clusters of patients with acute illness accompanied by hyperinflammatory syndrome in North America and some regions of Europe. A 1984 research article shows us that NSAIDs act by the inhibition of synthesis and release of prostaglandins and also inhibit the activation of neutrophils, which provoke inflammation by releasing products other than prostaglandins. NSAIDs also inhibit activation of neutrophils by inflammatory stimuli such as C5-derived peptides and leukotriene.
Long story short, drugs like ibuprofen can prove to be effective in decreasing the intensity of pain and inflammation in various infections and are now being tested on COVID-19 patients. This is a common approach to drug research in medicine, known as the drug repurposing approach where an old medicine is tested for its positive effects on a new disease. Though there was a lot of initial skepticism on the use of this drug on such a serious disease, the WHO finally clarified that there is no known side effect of ibuprofen on coronavirus infected patients.
One of the major limitations of drawing conclusions from theoretical hypotheses or clinical experiments is that it should always be taken with a pinch of salt. There are a lot of examples from the medical literature that show that theoretical results do not always correspond to clinical trials. Epidemiologic studies that have identified ibuprofen with negative respiratory outcomes are subject to a number of biases. These biases include protopathic bias and channeling bias. It is worth noticing that more severe viral infections such as influenza need a stronger anti-inflammatory drug than ibuprofen, so a potentially harmful outcome is more likely to be from the severity of the disease, rather than the drug itself.
What stands now is that clinical tests are being performed on patients affected with the SARS-CoV-2 virus to test the efficiency of ibuprofen in keeping patients off the ventilator. It must be noted that the formulation of ibuprofen being tested for is the special ‘lipid’ formulation of the drug and not the same as the usual tablets we receive at pharmacies. Lipid ibuprofen has shown to be effective at relatively low doses than the high-dose standard ibuprofen for diseases like Arthritis, and thus, could prove to be essential as a low-cost medicine in battling the pandemic.
Does ibuprofen carry strong side effects with it? No evidence to date establishes this fact. Can ibuprofen be used to cure patients? Maybe, but no evidence has shown us this either. All we know is that NSAID drugs like ibuprofen can act as an anti-inflammatory drug in the coronavirus infection, and can be safely prescribed to patients with mild-to-moderate symptoms. It would possibly take a lot more clinical research to fully establish or remove the use of such a drug, but what stands now, is that drug research is progressing at a great speed, and the outcome does instill a sense of hope.