1 research outputs found
Safety and potential efficacy of cyclooxygenase-2 inhibitors in coronavirus disease 2019
Objectives While the safety of nonâsteroidal antiâinflammatory drugs in COVIDâ19 has been questioned, they may be beneficial given the hyperâinflammatory immune response associated with severe disease. We aimed to assess the safety and potential efficacy of cyclooxygenaseâ2 (COXâ2) selective inhibitors in highârisk patients. Methods Retrospective study of patients with COVIDâ19 pneumonia and aged â„ 50 years who were admitted to hospital. Adverse outcomes analysed included supplemental oxygen use, intensive care unit admission, mechanical ventilation and mortality, with the primary endpoint a composite of any of these. Plasma levels of inflammatory cytokines and chemokines were measured in a subset. Results Twentyâtwo of 168 (13.1%) in the cohort received COXâ2 inhibitors [median duration 3 days, interquartile range (IQR) 3â4.25]. Median age was 61 (IQR 55â67.75), 44.6% were female, and 72.6% had at least one comorbidity. A lower proportion of patients receiving COXâ2 inhibitors met the primary endpoint: 4 (18.2%) versus 57 (39.0%), P = 0.062. This difference was less pronounced after adjusting for baseline difference in age, gender and comorbidities in a multivariate logistic regression model [adjusted odds ratio (AOR) 0.45, 95% CI 0.14â1.46]. The level of interleukinâ6 declined after treatment in five of six (83.3%) treatment group patients [compared to 15 of 28 (53.6%) in the control group] with a greater reduction in absolute ILâ6 levels (Pâvalue = 0.025). Conclusion Treatment with COXâ2 inhibitors was not associated with an increase in adverse outcomes. Its potential for therapeutic use as an immune modulator warrants further evaluation in a large randomised controlled trial