Aspirin and NSAID use and the risk of COVID-19

  1. David A. Drew
  2. Chuan-Guo Guo
  3. Karla A. Lee
  4. Long H. Nguyen
  5. Amit D. Joshi
  6. Chun-Han Lo
  7. Wenjie Ma
  8. Raaj S. Mehta
  9. Sohee Kwon
  10. Christina M. Astley
  11. Mingyang Song
  12. Richard Davies
  13. Joan Capdevila
  14. Mary Ni Lochlainn
  15. Carole H. Sudre
  16. Mark S. Graham
  17. Thomas Varsavsky
  18. Maria F. Gomez
  19. Beatrice Kennedy
  20. Hugo Fitipaldi
  21. Jonathan Wolf
  22. Tim D. Spector
  23. Sebastien Ourselin
  24. Claire J. Steves
  25. Andrew T. Chan

Reviewed by

Read the full article

Discuss this preprint

Start a discussion What are Sciety discussions?

Listed in

Log in to save this article

Abstract

Early reports raised concern that use of non-steroidal anti-inflammatory drugs (NSAIDs) may increase risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19). Users of the COVID Symptom Study smartphone application reported use of aspirin and other NSAIDs between March 24 and May 8, 2020. Users were queried daily about symptoms, COVID-19 testing, and healthcare seeking behavior. Cox proportional hazards regression was used to determine the risk of COVID-19 among according to aspirin or non-aspirin NSAID users. Among 2,736,091 individuals in the U.S., U.K., and Sweden, we documented 8,966 incident reports of a positive COVID-19 test over 60,817,043 person-days of follow-up. Compared to non-users and after stratifying by age, sex, country, day of study entry, and race/ethnicity, non-aspirin NSAID use was associated with a modest risk for testing COVID-19 positive (HR 1.23 [1.09, 1.32]), but no significant association was observed among aspirin users (HR 1.13 [0.92, 1.38]). After adjustment for lifestyle factors, comorbidities and baseline symptoms, any NSAID use was not associated with risk (HR 1.02 [0.94, 1.10]). Results were similar for those seeking healthcare for COVID-19 and were not substantially different according to lifestyle and sociodemographic factors or after accounting for propensity to receive testing. Our results do not support an association of NSAID use, including aspirin, with COVID-19 infection. Previous reports of a potential association may be due to higher rates of comorbidities or use of NSAIDs to treat symptoms associated with COVID-19.

One Sentence Summary

NSAID use is not associated with COVID-19 risk.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.04.28.21256261: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Participants provided informed consent to the use of app data for research purposes and agreed to privacy policies and terms of use.
    IRB: This research study was approved by the Partners Human Research Committee (IRB 2020P000909), King’s College London Ethics Committee (REMAS ID 18210, Review Reference LRS-19/20-18210), and the central ethics committee in Sweden (DNR 2020-01803).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, there are several limitations to our study. The nature of data collection relies on self-report and community testing practices. While we have accounted for multiple potential sources of potential confounding, there may be residual bias according to unmeasured confounders (e.g. access to healthcare, health-conscious behavior), as well as measurement bias (e.g. recall-bias for self-reports, NSAID use in response to COVID-19 infection), or selection bias (e.g. differential app participation or testing by NSAID use). To address these concerns, we adjusted for comorbidities for which aspirin use is an indication (e.g. heart disease) or baseline symptoms likely to prompt NSAID use (e.g. fever or headache). We also conducted sensitivity analyses in which we adjusted for the propensity to receive testing using IPW and restricted to those that received testing. Last, our approach through voluntary reporting is unlikely to be able to capture the effects of NSAIDs in relation to the most severe COVID-19 symptoms and complications. In conclusion, we find no evidence to support an increased risk for COVID-19 in those that regularly use aspirin or non-aspirin NSAIDs. These findings may offer reassurance to patients and providers regarding the safety of continuing use of aspirin for prevention of cardiovascular disease or cancer and the use of NSAIDs for treatment of chronic pain or other inflammatory conditions during the COVID-19 pandemic.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04331509RecruitingCOVID-19 Symptom Tracker

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.04.28.21256261 on medRxiv