Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review
Objectives To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival.Design Rapid systematic review.Participants Humans with viral respiratory...
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| Format: | Article |
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BMJ Publishing Group
2020-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/11/e040990.full |
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| author | Jan M Stratil Peter von Philipsborn Ani Movsisyan Eva Rehfuess Renke Biallas Simon Drees Karin Geffert Lisa Maria Pfadenhauer Kerstin Sell Brigitte Strahwald |
| author_facet | Jan M Stratil Peter von Philipsborn Ani Movsisyan Eva Rehfuess Renke Biallas Simon Drees Karin Geffert Lisa Maria Pfadenhauer Kerstin Sell Brigitte Strahwald |
| author_sort | Jan M Stratil |
| collection | DOAJ |
| description | Objectives To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival.Design Rapid systematic review.Participants Humans with viral respiratory infections, exposed to systemic NSAIDs.Primary outcomes Acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival.Results We screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution.Conclusions It is unclear whether the use of NSAIDs increases the risk of severe adverse outcomes in patients with viral respiratory infections. This absence of evidence should not be interpreted as evidence for the absence of such risk. This is a rapid review with a number of limitations.PROSPERO registration number CRD42020176056. |
| format | Article |
| id | doaj-art-aa106912377a42c793749ada87a326b5 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-aa106912377a42c793749ada87a326b52025-08-20T01:53:31ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-040990Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic reviewJan M Stratil0Peter von Philipsborn1Ani Movsisyan2Eva Rehfuess3Renke Biallas4Simon Drees5Karin Geffert6Lisa Maria Pfadenhauer7Kerstin Sell8Brigitte Strahwald9Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Faculty of Medicine, LMU Munich, Munich, GermanyPettenkofer School of Public Health, Munich, GermanyPettenkofer School of Public Health, Munich, GermanyInstitute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, GermanyInstitute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, GermanyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, GermanyInstitute for Medical Information Processing, Biometry, and Epidemiology – IBE, LMU Munich, Munich, GermanyInstitute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, GermanyInstitute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, GermanyInstitute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, GermanyObjectives To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival.Design Rapid systematic review.Participants Humans with viral respiratory infections, exposed to systemic NSAIDs.Primary outcomes Acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival.Results We screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution.Conclusions It is unclear whether the use of NSAIDs increases the risk of severe adverse outcomes in patients with viral respiratory infections. This absence of evidence should not be interpreted as evidence for the absence of such risk. This is a rapid review with a number of limitations.PROSPERO registration number CRD42020176056.https://bmjopen.bmj.com/content/10/11/e040990.full |
| spellingShingle | Jan M Stratil Peter von Philipsborn Ani Movsisyan Eva Rehfuess Renke Biallas Simon Drees Karin Geffert Lisa Maria Pfadenhauer Kerstin Sell Brigitte Strahwald Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review BMJ Open |
| title | Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review |
| title_full | Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review |
| title_fullStr | Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review |
| title_full_unstemmed | Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review |
| title_short | Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review |
| title_sort | adverse effects of non steroidal anti inflammatory drugs in patients with viral respiratory infections rapid systematic review |
| url | https://bmjopen.bmj.com/content/10/11/e040990.full |
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